1996 Shy-Drager Conference Transcripts - 4 of 4

[Guest guest]

SDS CONFERENCE 10/12/96

DISCUSSION WITH DR. BOB FEALEY

I would like to make this quite informal. How many of you have been

diagnosed with pure autonomic failure? How many have been diagnosed

with multiple system atrophy or Shy-Drager syndrome? So, a fairly

equal mixture. The first update I will give you actually applies to

both groups. I realize that there are a number of you that have tried

the drug and or off the drug. After a number clinical trials we are

finally done. Midodrine was approved for orthostatic hypotension. So

this again is a medicine used for the low blood pressure problem. How

many of you have had clear cut symptoms of low blood pressure? How

many of you have actually gone out? So this is the kind of medicine

that may help if you haven't tried it, because it raises blood

pressure. Midodrine is about to be released from the wholesaler in

about a week, that means your pharmacist may have it in two to three

weeks.

It is a drug that has been around for awhile. About eleven years ago

I tried it on some patients with some success. Then it went through a

period of time where there was not good studies that supported its

use. In fact, this year the drug was almost delayed once again.

Finally after a push from a number of the panel members you will see

up here in a few moments, the drug was finally approved. Midodrine

will cost approximately $1.40 per tablet. So, unfortunately, like

many medicines it is not inexpensive. Typically a person will be

using anywhere between three to eight tablets a day if it seems to

help raise blood pressure. The drug is really quite free of side

effects although it does cause a goose bump reaction, a kind of tingly

sensation. And unfortunately it raises both the lying and standing

blood pressure.

How many of you have high blood pressure when you lay down? Quite a

few it looks like. Does anyone know other ways of lowering the high

blood pressure when lying down, besides medication and raising the

head of the bed? Did someone say eat a snack at bedtime? That is one

thing you can do. A snack at bedtime will frequently lower the blood

pressure. You can do some exercise while you are in bed. Exercise

will lower the blood pressure. And also, though I don't recommend

this for the day time, but at night time a glass of wine will dilate

the blood vessels and lower blood pressure too. So, again, if you are

going to be in bed and not getting up in the next hour or two and

going to the bathroom, then some of these other non-medical ways are

useful for lowering blood pressure when it is high lying down. Most

of these measures will not last more than three hours, so by the early

morning hours your blood pressure should be higher. You want to be

tilted up high enough at night that you get some fall in blood

pressure to prevent such a marked fall in blood pressure upon standing

in the morning.

Q: Do you ever use Nipedipine to lower blood pressure at night?

A: Yes, that is another fairly short acting medicine that can do that,

I think I would be a little careful about that one only that it is in

a capsule so that it is hard to divide it into a smaller dose. It can

be really figurous about lowering blood pressure in some people, maybe

not dangerously low, but low enough that it could make people pass out

when they stand up, so just be aware of that.

Dr. Fealey: Let's go back to Midodrine, we really have found that it

is quite safe. This medicine is a reasonable one to try if you are

having trouble with low blood pressure. It is usually used with

Florinef. It is probably better than the blood pressure raising

medicines like Epidrine and Phenopropenol. It tends not to

stimulate the heart quite so much and it tends to be a little better

tolerated in that it doesn't stimulate the central nervous system, it

stimulates the peripheral nervous system so you don't get much of a

tremor, or nervous, or anxiety when you take it as opposed to other

medicine that we have used. There is a couple of studies out now that

suggests that if you have low blood pressure when you eat, that

Midodrine might be a good one to take before you eat the meal to help

prevent the very low blood pressure.