Core IM | Internal Medicine Podcast #188 Orthostatic Hypotension Part 2: Gray Matters Segment
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Sep 22, 2025 Explore the complexities of managing orthostatic hypotension with insightful discussions on various medications, including midodrine and fludrocortisone. Discover the challenges posed by autonomic failure and how to navigate simultaneous hypertension. Learn about practical strategies for patient care, such as risk stratification and the importance of physical therapy for safe discharge. This conversation prepares healthcare providers to tackle nuanced scenarios in clinical practice effectively.
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Start Drugs To Restore Function
- Start medications for orthostatic hypotension when ADLs or falls are affected to restore function.
- Use drugs as a temporary bridge to enable mobility and rehabilitation rather than assuming lifelong therapy.
Time Midodrine With Activity
- Time midodrine to coincide with activity and check orthostatics about an hour after dosing.
- Avoid evening doses to reduce risk of supine hypertension and test response before titrating.
Midodrine Worked But Caused Problems
- Nick started midodrine and improved standing systolic BP into the 100s but then saw supine BP rise into the 180s.
- Midodrine also worsened his patient's urinary retention, forcing reassessment and medication changes.