Orthostatic Intolerance

Symptoms of cerebral hypoperfusion or autonomic overaction which develop while the subject is standing, but are relieved on recumbency. Types of this include NEUROCARDIOGENIC SYNCOPE; POSTURAL ORTHOSTATIC TACHYCARDIA SYNDROME; and neurogenic ORTHOSTATIC HYPOTENSION. (From Noseworthy, JH., Neurological Therapeutics Principles and Practice, 2007, p2575-2576)

Also Known As:

Networked: 232 relevant articles (19 outcomes, 12 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Hypotension (Low Blood Pressure)
2.	Hypovolemia
3.	Primary Dysautonomias (Dysautonomia)
4.	Tachycardia (Tachyarrhythmias)
5.	Syncope (Fainting)

Experts

1.	Robertson, David: 9 articles (03/2007 - 03/2002)
2.	Levine, Benjamin D: 7 articles (02/2013 - 01/2002)
3.	Karabin, Beverly: 7 articles (03/2012 - 07/2008)
4.	Grubb, Blair P: 7 articles (03/2012 - 07/2008)
5.	Biaggioni, Italo: 7 articles (03/2007 - 01/2002)
6.	Kanjwal, Khalil: 6 articles (03/2012 - 10/2010)
7.	Saeed, Bilal: 6 articles (03/2012 - 10/2010)
8.	Kanjwal, Yousuf: 6 articles (03/2012 - 10/2010)
9.	Stewart, Julian M: 5 articles (05/2013 - 12/2002)
10.	Diedrich, André: 5 articles (03/2007 - 01/2002)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Orthostatic Intolerance:

1.	FludrocortisoneIBA 03/01/2004 - "Fludrocortisone is not recommended as a countermeasure for spaceflight-induced orthostatic intolerance." 11/05/2002 - "A high frequency of positive results on tilt-table testing has confirmed an association between the chronic fatigue syndrome and orthostatic intolerance; however, treatment with the salt-retaining steroid fludrocortisone, which is usually beneficial in primary chronic autonomic failure, does not seem to be beneficial in the chronic fatigue syndrome. " 12/01/2011 - "Fludrocortisone improves nausea in children with orthostatic intolerance (OI)." 07/01/2014 - "We hypothesized that orthostatic intolerance (OI) is associated with gastric dysrhythmias, nausea, and abdominal pain, which improves using fludrocortisone to treat OI. " 10/01/2000 - "Clinical improvement in patients with orthostatic intolerance after treatment with bisoprolol and fludrocortisone."
2.	Pyridostigmine Bromide (Pyridostigmine)FDA LinkGeneric 02/01/2007 - "Pyridostigmine bromide has been associated with improved baroreceptor sensitivity and presents a novel approach to treatment of orthostatic intolerance. " 06/01/2011 - "The subgroup of POTS patients who can tolerate oral pyridostigmine may demonstrate improvement in their standing HR, standing diastolic blood pressure, and clinical symptoms of orthostatic intolerance." 06/01/2011 - "Pyridostigmine improved symptoms of orthostatic intolerance in 88 of 203 (43%) of total patients or 88 of 172 (51%) who were able to tolerate the drug. " 02/01/2007 - "To review the efficacy of pyridostigmine bromide for the treatment of orthostatic intolerance. " 02/01/2007 - "At this time, long-term data are insufficient to support recommending the routine use of pyridostigmine bromide for treatment of orthostatic intolerance."
3.	Norepinephrine (Noradrenaline)FDA LinkGeneric 08/01/1997 - "Patients were enrolled in the study if they had orthostatic intolerance, together with a raised upright plasma norepinephrine (> or = 600 pg/mL). " 04/01/2005 - "Idiopathic orthostatic intolerance (IOI) is a common disorder that is characterized by chronic orthostatic symptoms and substantial increases in heart rate and plasma norepinephrine concentrations that are disproportionately high while standing. " 03/01/2002 - "Thus, the previously reported loss of function of the Ala(457)Pro variant associated with orthostatic intolerance is only partly due to a reduction in plasma membrane expression of the transporter, and is mainly caused by the pronounced reduction in the apparent affinity of norepinephrine." 01/22/2002 - "Selective norepinephrine reuptake inhibition as a human model of orthostatic intolerance." 01/01/2002 - "Orthostatic intolerance is common when astronauts return to Earth: after brief spaceflight, up to two-thirds are unable to remain standing for 10 min. Previous research suggests that susceptible individuals are unable to increase their systemic vascular resistance and plasma noradrenaline concentrations above pre-flight upright levels. "
4.	hydroxide ionIBA 07/01/2001 - "The symptoms of orthostatic intolerance are correlated with OH, but only 1 out of 4 patients showed symptoms. " 07/01/2001 - "By logistic regression analysis, association between higher level of systolic blood pressure and global OH was found, also with the presence of orthostatic intolerance symptoms (although only 25.6% of the patients with OH showed symptoms) and smoking. " 01/01/2014 - "To study the incidence of MCI and dementia and their relationship to OH and subclinical OH with orthostatic symptoms (orthostatic intolerance). " 12/01/2015 - "Early postoperative mobilization is essential for rapid recovery but may be impaired by orthostatic intolerance (OI) and orthostatic hypotension (OH), which are highly prevalent after major surgery. " 05/01/2015 - "Because frailty may represent impaired response to physiological stress we explored the associations between frailty and orthostatic hypotension (OH), and orthostatic intolerance (OI). "
5.	ReninIBA 08/01/1997 - "Taken together, these observations suggest that reduced plasma renin activity may be an important pathophysiologic component of the syndrome of orthostatic intolerance." 11/01/1985 - "Blood pressure and plasma renin activity as predictors of orthostatic intolerance." 01/01/2003 - "Orthostatic intolerance after HDBR was observed in 10 subjects, the BP response was blunted, and noradrenaline as well as plasma renin activity (PRA) responses were augmented (NA 3.10+/-0.33 mol.l(-1), p<0.001; PRA 2.98+/-1.12 vs. 0.85+/-0.15 ng.ml(-1), p<0.05). " 03/15/2014 - "Renin-aldosterone paradox in patients with myalgic encephalomyelitis and orthostatic intolerance." 01/01/1997 - "Recent studies of the hyperadrenergic (elevated plasma norepinephrine) subgroup of orthostatic intolerance is documenting a clinical spectrum including attenuated plasma renin activity and aldosterone, reduced supine blood volume coupled with dynamic orthostatic hypovolemia, elevated plasma norepinephrine and epinephrine, impaired clearance of norepinephrine from the circulation and evidence of partial dysautonomia. "
6.	Epinephrine (Adrenaline)FDA LinkGeneric 02/01/2000 - "In young individuals, orthostatic intolerance is associated with marked increases in plasma epinephrine (EPI) concentrations and attenuated rises in plasma norepinephrine (NE) concentrations. " 02/01/2000 - "Norepinephrine and epinephrine responses during orthostatic intolerance in healthy elderly men." 01/01/1997 - "Recent studies of the hyperadrenergic (elevated plasma norepinephrine) subgroup of orthostatic intolerance is documenting a clinical spectrum including attenuated plasma renin activity and aldosterone, reduced supine blood volume coupled with dynamic orthostatic hypovolemia, elevated plasma norepinephrine and epinephrine, impaired clearance of norepinephrine from the circulation and evidence of partial dysautonomia. "
7.	AldosteroneIBA 03/15/2014 - "Renin-aldosterone paradox in patients with myalgic encephalomyelitis and orthostatic intolerance." 01/01/1997 - "Recent studies of the hyperadrenergic (elevated plasma norepinephrine) subgroup of orthostatic intolerance is documenting a clinical spectrum including attenuated plasma renin activity and aldosterone, reduced supine blood volume coupled with dynamic orthostatic hypovolemia, elevated plasma norepinephrine and epinephrine, impaired clearance of norepinephrine from the circulation and evidence of partial dysautonomia. "
8.	Octreotide (Sandostatin)FDA LinkGeneric 01/01/2012 - "Octreotide may improve symptoms in some patients with refractory orthostatic intolerance." 01/01/2012 - "Twelve patients aged 33 ± 18 years, eight (66.7%) females, were found to have symptoms of refractory orthostatic intolerance and failed multiple regimens of medication and were ultimately treated with octreotide administration. " 01/01/2012 - "Use of octreotide in the treatment of refractory orthostatic intolerance." 12/01/2007 - "Protocol 2 Patients with POTS or orthostatic intolerance were given 10, 20, or 30 mg of octreotide LAR over three months. " 12/01/2007 - "Octreotide LAR improved standing time and suppressed tachycardia in patients with orthostatic intolerance."
9.	Carbon MonoxideIBA 03/01/2007 - "Microgravity (microG)-induced orthostatic intolerance (OI) in astronauts is characterized by a marked decrease in cardiac output (CO) in response to an orthostatic stress. " 10/01/2015 - "Other co-morbid conditions associated with POTS are not clearly attributable to orthostatic intolerance. " 03/01/2010 - "Twenty-four women undergoing breast cancer surgery performed a mobilization procedure before and 30 min after surgery, with measurement of arterial pressure, stroke volume (SV), cardiac output (CO), and total peripheral resistance (TPR) (Modelflow), besides evaluation of cerebral and muscle oxygenation (near-infrared spectroscopy) and recording of symptoms of orthostatic intolerance. "
10.	Nicotinic Receptors (Nicotinic Acetylcholine Receptor)IBA 08/01/2009 - "Two series of PLEX temporarily, but dramatically improved orthostatic intolerance and hypotension and baroreflex function, in a manner inversely related to ganglionic neuronal nicotinic receptor antibody titer. " 03/12/2009 - "Autoimmune autonomic ganglionopathy is a disorder of isolated autonomic failure associated with antibodies to the nicotinic acetylcholine receptor of the autonomic ganglia resulting in severe orthostatic intolerance, syncope, constipation, gastroparesis, urinary retention, dry mouth, dry eyes, blurred vision and anhidrosis. "

Therapies and Procedures

1.	Bed Rest (Bedrest) 07/01/2000 - "Vernikos et al reported that 1 G intermittent exposures with and without walking exercise was effective in preventing physiologic deconditioning with 4-d, -6 degrees bedrest, and standing at 1 G was most effective in preventing orthostatic intolerance. " 03/01/2014 - "To evaluate the efficacy of the GCG to prevent orthostatic intolerance after a 14-day 6° head-down tilt bed rest (BR) and to determine whether wearing thigh-high compression garments impairs recovery from BR. " 05/01/2012 - "This study examined the effectiveness of a short-duration but high-intensity exercise countermeasure in combination with a novel oral volume load in preventing bed rest deconditioning and orthostatic intolerance. " 01/01/2012 - "The objective of this study is to assess by echography and Doppler the Cerebral (Vmca), Aortic (Vao) and Femoral (Vfem) arterial flow velocity and calf vein (Tibial, Gastrocnemius) section (Tib, Gast) during orthostatic intolerance (OI) test after a 60-day, head down tilt bed rest (HDBR). " 12/01/2001 - "Findings from recent bed rest and spaceflight human studies have indicated that the inability to adequately elevate the peripheral resistance and the altered autoregulation of cerebral vasculature are important factors in postflight orthostatic intolerance. "
2.	Lower Body Negative Pressure 06/01/1994 - "Lower body negative pressure experiments conducted aboard Space Shuttle flights provide data about the deadaptation response of the cardiovascular system to orthostatic stress occurring during periods of zero gravity, and about protection against postflight orthostatic intolerance. " 01/31/2007 - "The aim of our study was to determine whether impaired cerebral autoregulation contributes to orthostatic intolerance during lower body negative pressure in diabetic patients. " 07/01/2015 - "space program, LBNP was devised as a way to test for orthostatic intolerance. " 01/01/2015 - "We examine whether lower limb blood pooling rate during lower body negative pressure is linked to orthostatic intolerance. " 01/01/2014 - "In this review paper, data are presented from experiments using graded lower body negative pressure (LBNP) as a method to induce orthostatic intolerance in two experimental human models: (1) comparison of heart rate and autonomic responses in individuals with relatively high and low tolerance to LBNP; and (2) vagal and sympathetic blockade of cardiac neural control. "
3.	Ventriculoperitoneal Shunt 08/01/2009 - "A ventriculo-peritoneal shunt was performed, and after surgery the orthostatic intolerance improved. "
4.	Aftercare (After-Treatment) 10/01/2000 - "Clinical improvement in patients with orthostatic intolerance after treatment with bisoprolol and fludrocortisone."
5.	Fluid Therapy (Oral Rehydration Therapy) 10/01/2013 - "Does goal-directed fluid therapy affect postoperative orthostatic intolerance?: A randomized trial." 03/01/2010 - "With the used regimen of anaesthesia, pain treatment, and fluid therapy, orthostatic intolerance is infrequent 30 min after breast cancer surgery, apparently because the cardiovascular response and tissue oxygenation are preserved. "