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Treatment of Orthostatic Hypotension with Dihydroergotamine and Caffeine

ROBERT D. HOELDTKE, M.D., Ph.D.; STEPHEN T. CAVANAUGH, B.A.; JOHN D. HUGHES, B.A.; and MARCIA POLANSKY, Sc.D.
[+] Article and Author Information

Grant support: by grants AM32239 and RR00394 to the General Clinical Research Center from the Public Health Service.

▸Requests for reprints should be addressed to Robert D. Hoeldtke, M.D., Ph.D.; Temple University Health Sciences Center, 3401 North Broad Street; Philadelphia, PA 19140.


Philadelphia, Pennsylvania


© 1986 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1986;105(2):168-173. doi:10.7326/0003-4819-105-2-168
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Eight patients with orthostatic hypotension were treated with subcutaneous dihydroergotamine. Two doses of the drug (6.5 and 13 µg/kg) or placebo were given in a random sequence at 0600 h, and blood pressures were measured hourly throughout the day with patients in both supine and upright positions. To assess the effect of postprandial hypotension on the therapeutic response to dihydroergotamine, we gave breakfast, lunch, and supper on a fixed schedule at 0900 h, 1200 h, and 1700 h. Dihydroergotamine had a pressor effect in seven of the eight patients during the fasting period (0600 h to 0900 h), but this agent did not counteract the hypotensive effect of eating. Concomitant administration of caffeine (250 mg, 30 minutes before breakfast), however, maintained the beneficial effect of dihydroergotamine during the postprandial period. The combination of subcutaneous dihydroergotamine and caffeine represents a new therapeutic option for patients with severe autonomic neuropathy.

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