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: 381 relevant articles (31 outcomes, 30 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Orthostatic Hypotension (Postural Hypotension)
2.	Syncope (Fainting)
3.	Hypotension (Low Blood Pressure)
4.	Dizziness (Lightheadedness)
5.	Tachycardia (Tachyarrhythmias)

Experts

1.	Robertson, David: 11 articles (03/2007 - 01/2002)
2.	Levine, Benjamin D: 9 articles (01/2019 - 01/2002)
3.	Grubb, Blair P: 7 articles (01/2021 - 07/2008)
4.	Karabin, Beverly: 7 articles (03/2017 - 07/2008)
5.	Biaggioni, Italo: 7 articles (03/2007 - 01/2002)
6.	Stewart, Julian M: 6 articles (11/2019 - 12/2002)
7.	Diedrich, André: 6 articles (01/2019 - 01/2002)
8.	Jordan, Jens: 6 articles (01/2019 - 01/2002)
9.	Freeman, Roy: 6 articles (01/2017 - 08/2002)
10.	Rowe, Peter C: 5 articles (10/2022 - 12/2011)

Drugs and Biologics

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

1.	SaltsIBA 01/01/2022 - "The efficacy of the response, in terms of the improvement in subjective and objective markers of orthostatic intolerance, and any potential deleterious effect on supine blood pressure, should be routinely monitored in individuals on high salt regimes." 12/01/2020 - "Our meta-analysis provides low-quality evidence of a short-term improvement in orthostatic intolerance with increased salt intake. " 12/01/2020 - "Interventional studies that increased salt intake in individuals with orthostatic intolerance syndromes were included. " 12/01/2020 - "We sought to summarize the evidence for increased salt intake in patients with orthostatic intolerance syndromes. " 12/01/2020 - "Increased Salt Intake for Orthostatic Intolerance Syndromes: A Systematic Review and Meta-Analysis."
2.	hydroxide ionIBA 12/01/2021 - "This study aimed to determine the prevalence, co-occurrence and determinants of OH and orthostatic intolerance symptoms in geriatric rehabilitation inpatients. " 07/01/2020 - "This study recruited 663 patients with orthostatic intolerance (78 with and 585 without OH, as confirmed by the HUTT) and compared their clinical characteristics. " 12/01/2022 - "We compared the results between the patients with OH (n = 38) and those with NOI (normal head-up tilt table test despite orthostatic intolerance, n = 117). " 11/01/2022 - "Increase in number of co-morbidities (ORadj = 1.82 [95%CI = 1.36, 2.48]), number of medicines used (ORadj = 1.73 [95%CI = 1.28, 2.34]), and orthostatic intolerance (ORadj = 3.67 [95%CI = 1.13, 11.94]) increased the odds of having OH. " 12/01/2021 - "Poorer health in patients with orthostatic intolerance symptoms highlights the need to assess symptoms in clinical practice, independent of an OH diagnosis."
3.	FludrocortisoneIBA 03/01/2004 - "Fludrocortisone is not recommended as a countermeasure for spaceflight-induced orthostatic intolerance." 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. " 01/01/1994 - "The purpose of this study was to compare the effectiveness of saline load to fludrocortisone (florinef) as countermeasures for reduced plasma volume and orthostatic intolerance after spaceflight. " 10/01/2000 - "Clinical improvement in patients with orthostatic intolerance after treatment with bisoprolol and fludrocortisone."
4.	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."
5.	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. "
6.	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. "
7.	CalciumIBA 07/01/1997 - "Results indicate that 4 hr. standing was most effective for orthostatic intolerance, walking was most effective in achieving peak oxygen consumption, 4 hr. of standing or walking had the best effect on plasma volume, and 4 hr. of walking was most effective in maintaining urinary calcium excretion." 01/01/1967 - "Studies prior to the advent of space flight led to the prediction of orthostatic intolerance, muscular weakness, and calcium loss. " 01/01/1992 - "It is well known that long-term exposure to microgravity causes a number of physiological and biochemical changes in humans; among the most significant are: 1) negative calcium balance resulting in the loss of bone; 2) atrophy of antigravity muscles; 3) fluid shifts and decreased plasma volume; and 4) cardiovascular deconditioning that leads to orthostatic intolerance. "
8.	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. "
9.	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. "
10.	Biomarkers (Surrogate Marker)IBA 01/01/2023 - "Selected biomarkers of orthostatic intolerance." 01/01/2021 - "Prognostic Value of Biomarkers in Children and Adolescents With Orthostatic Intolerance." 01/01/2018 - "Hypocapnic cerebral hypoperfusion: A biomarker of orthostatic intolerance." 02/01/2016 - "Distinct neurohumoral biomarker profiles in children with hemodynamically defined orthostatic intolerance may predict treatment options." 09/01/2015 - "Autonomic activity and biomarker behavior in supine position and after passive postural stress in different orthostatic intolerance syndromes."

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. " 01/01/2016 - "Centrifugation for as little as 30 min per day was found to be effective in mitigating orthostatic intolerance and strength in postural muscle after 5 days of bed rest, but it was not effective in mitigating plasma volume loss. " 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). "
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. " 11/01/2022 - "Conclusions Combination of real-time magnetic resonance imaging, LBNP, and continuous blood pressure monitoring provides a promising new approach to study orthostatic intolerance mechanisms in human beings." 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. " 06/01/2023 - "Additionally, LBNP application (used singly or together with head up tilt, HUT) is useful in understanding the physiology of orthostatic intolerance. " 01/01/2022 - "This suggesting that a combination of LBNP test with HUT test might work the best in orthostatic intolerance assessment."
3.	Therapeutics 01/03/2001 - "Further studies are needed to determine whether other medications or combination therapy are more effective in treating orthostatic intolerance in patients with CFS." 02/01/2022 - "However, recent studies and evidence from overlapping conditions suggest that in addition to being considered a disorder of the peripheral nervous system, POTS should be viewed also as a central nervous system (CNS) disorder given (1) significant CNS symptom burden in patients with POTS; (2) structural and functional differences found on neuroimaging in patients with POTS and other forms of orthostatic intolerance; (3) evidence of cerebral hypoperfusion and possible alteration in cerebrospinal fluid volume, and (4) positive response to medications targeting the CNS and non-pharmacologic CNS therapies. " 08/01/2022 - "A causal therapy for ME/CFS has not been established; the focus is on symptoms relief, treatment of the often accompanying orthostatic intolerance, and assistance with anticipatory energy management (pacing). " 11/30/2021 - "Orthostatic intolerance syndromes are commonly diagnosed in patients referred to the cardiologist after HCT, involving approximately 1/3 of patients and requiring pharmacological therapy to cope with symptoms in the majority of cases. " 01/01/2021 - "These include neuromuscular limitations that could be treated with manual forms of therapy, orthostatic intolerance and POTS for which there are multiple medications and non-pharmacologic therapies, treatable allergic and mast cell phenomena, and neurologic abnormalities that may require specific treatment. "
4.	Aftercare (After-Treatment) 08/15/2021 - "Before treatment, 6 of the 27 patients had orthostatic intolerance with an inability to complete the 10-min standing test; after treatment, this symptom resolved in 4 and improved in 2 patients. " 01/01/2018 - "The orthostatic intolerance questionnaire (OIQ), Beck depression inventory-II (BDI-II), and short-form health survey (SF-36) were conducted at baseline, 1 and 3 months after treatment. " 08/15/2021 - "The performance status score (0-9), orthostatic intolerance during the 10-min standing test, neurologic disequilibrium, and neuropathic pain were compared before and after treatment. " 01/01/2021 - "All patients showed persistent symptoms of autonomic dysfunction after treatment of spontaneous intracranial hypotension and orthostatic intolerance was confirmed with head-up tilt table test. " 12/01/2023 - "The performance status score (0-9) for restricting activities of daily living, orthostatic intolerance (OI) during a 10-min standing test, neurologic disequilibrium diagnosed as unstable standing with their feet together and eyes closed, neuropathic pain or fibromyalgia, and muscle weakness were compared before and after treatment. "
5.	Qigong (Qi Gong) 02/01/1999 - "Hypoxia is more effective in countermeasuring orthostatic intolerance after weightlessness than Qigong."