Abstract | OBJECTIVES: BACKGROUND: METHODS: Ambulatory, patient-controlled norepinephrine therapy was initiated in six patients with orthostatic hypotension due to primary autonomic failure that had been refractory to conventional treatment. Before this therapy, three patients were bedridden; one was immobilized in a wheelchair. All had recurrent syncope and tolerated upright tilt-table testing for less than 15 min despite extensive medical treatment. For ambulatory treatment, a port-a-cath system was implanted and, using a CADD ambulatory infusion pump, norepinephrine was infused in individually adjusted dosages. RESULTS:
Norepinephrine infusion therapy enabled all patients to sit, stay and walk around for more than 45 min. One patient died after a five-year treatment period, another after nine months because of nonhemorrhagic brain stem infarctions, both in the absence of norepinephrine treatment. The remaining four patients are still mobile after a period of 19, 10, 9 and 7 months, respectively. None of them has suffered complications due to arterial hypo- or hypertension, and there has been no infection of the infusion system. CONCLUSIONS: In these selected patients with refractory orthostatic hypotension due to primary autonomic dysfunction, ambulatory norepinephrine infusion therapy has proved to be a promising new therapeutic option. Further long-term studies including more patients are necessary to assess additional indications, reliability and safety of this new method.
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Authors | O Oldenburg, A Mitchell, J Nürnberger, S Koeppen, R Erbel, T Philipp, A Kribben |
Journal | Journal of the American College of Cardiology
(J Am Coll Cardiol)
Vol. 37
Issue 1
Pg. 219-23
(Jan 2001)
ISSN: 0735-1097 [Print] United States |
PMID | 11153742
(Publication Type: Journal Article)
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Chemical References |
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Topics |
- Aged
- Ambulatory Care
- Autonomic Nervous System Diseases
(drug therapy)
- Female
- Humans
- Hypotension, Orthostatic
(drug therapy)
- Infusion Pumps, Implantable
- Male
- Middle Aged
- Norepinephrine
(administration & dosage)
- Treatment Outcome
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