Orthostatic Hypotension in Psychiatric Medications

Definition and Diagnosis

Orthostatic hypotension is defined as a decrease in systolic blood pressure of ≥20 mmHg or diastolic blood pressure of ≥10 mmHg within 3 minutes of standing from a supine or seated position, according to the European Society of Cardiology 1
The European Heart Association notes that orthostatic hypotension can cause symptoms such as dizziness, light-headedness, weakness, fatigue, and syncope 2
Postural giddiness, the sensation of unsteadiness when changing positions, may accompany orthostatic hypotension, as described by the European Heart Association 2

Diuretics can cause orthostatic hypotension through volume depletion, as reported by the American Heart Association 3
Vasodilators may also contribute to orthostatic hypotension, according to the European Society of Cardiology 1

The European Heart Association recommends measuring blood pressure after 5 minutes of lying/sitting and then at 1 and/or 3 minutes after standing to check for orthostatic changes 2, 1
Monitoring for symptoms such as dizziness, light-headedness, weakness, or syncope is crucial, as advised by the European Heart Association 2

Increasing fluid intake to 2-3 liters daily and salt consumption, if not contraindicated, can help manage orthostatic hypotension, as suggested by the European Society of Cardiology 4, 1
Implementing physical counter-maneuvers during symptom onset, such as leg-crossing and muscle tensing, can also be beneficial, according to the European Society of Cardiology 4, 1
The American Diabetes Association recommends smaller, more frequent meals to reduce post-prandial hypotension 5, 1
Gradual staged movements with postural change and compression garments for the legs and abdomen may also be helpful, as reported by the European Society of Cardiology 4, 1
Midodrine, an alpha-1 agonist, may be considered for severe cases of orthostatic hypotension, as noted by the American Diabetes Association 5, 4
Fludrocortisone may be used in persistent cases, according to the European Society of Cardiology 4
Droxidopa is FDA-approved for neurogenic orthostatic hypotension, as reported by the American Diabetes Association 6, 4