This trial is designed to study the effects of various mechanistically unique medications in controlling excessive increases in heart rate with standing and in improving the symptoms of orthostatic intolerance in patients with this disorder.
This trial is designed to study the effects of various mechanistically unique medications in controlling excessive increases in heart rate with standing and in improving the symptoms of orthostatic intolerance in patients with this disorder. Pilot drug trials are 4h in duration from \~9am -1pm. Different short-acting medications will be used to determine their acute hemodynamic effects in patients with orthostatic intolerance.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
150
250 mg PO x 1
10-40 mg PO x 1 dose
No intervention - just monitoring
Vanderbilt University Autonomic Dysfunction Center
Nashville, Tennessee, United States
Increase in heart rate with standing
Time frame: 1-4 hours
Sitting heart rate
Time frame: 1-4 hours
Standing heart rate
Time frame: 1-4 hours
Blood pressure
Time frame: 1-4 hours
Decrease in blood pressure with standing
Time frame: 1-4 hours
Orthostatic symptoms score
Time frame: Baseline, 2h, 4h
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Clonidine 0.05-0.3 mg PO x 1 dose
Entacapone 200-400 mg PO x 1 dose
Entacapone 200-400 mg PO x 1 dose AND propranolol 20 mg PO x 1 dose
Atomoxetine 10-40 mg PO x 1 dose AND propranolol 20 mg PO x 1 dose
Indomethacin 25-50 mg PO x 1 dose
mecamylamine 1.25-5 mg PO x 1 dose
Isosorbide dinitrate 5-20 mg PO x 1 dose
melatonin 3 mg PO x 1 dose
midodrine 2.5-10 mg PO x 1 dose
modafinil 100-200 mg PO x 1 dose
octreotide 12.5-50 mcg Subcutaneous x 1 dose
lactose tablet x 1 pill
Propranolol 10-80 mg PO x 1-2 dose
Modafinil 100-200 mg PO x 1 dose AND Propranolol 20 mg PO x 1 dose
sertraline 25-50 mg PO x 1 dose
1 liter IV over 2 hours
16 fluid ounces
Breathing through a dead space tube
memantine 5-20 mg PO x 1 dose
Using large blood pressure cuffs linked together, they are wrapped around the subjects abdomen and inflated to generate increased pressure to below tolerably threshold.