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Treatment of orthostatic hypotension due to autonomic failure frequently necessitates use of pressor agents. Because venous pooling contributes significantly to this disorder, the venoconstrictive properties of ergotamine offer theoretical advantages over pure arteriolar pressor agents. However, the low and erratic bioavailability of oral preparations has hindered the use of ergotamine. Accordingly, the efficacy of inhaled ergotamine tartrate (1 puff, 0.36 mg) was compared to placebo in 8 patients with severe autonomic failure. Blood pressure was monitored in the seated position with an automated device. Ergotamine produced significant increases in systolic (29 ± 5 mm Hg, p < 0.01 by analysis of variance) and diastolic (13 ± 1 mm Hg, p < 0.001) blood pressures compared to placebo (−9 ± 5 and −2 ± 3, respectively). Upright blood pressure 2 hours after administration was significantly greater with ergotamine () vs placebo (). Motionless standing time, a measurement of functional capacity, also improved with ergotamine (200 ± 58 vs 85 ± 22 seconds). No side effects were noted, but patients with coronary or peripheral artery disease were excluded. Inhaled ergotamine may provide an effective and practical therapy for disabling orthostatic hypotension due to autonomic failure.
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- Etiology, pathogenesis and treatment of orthostatic hypotension.Comprehensive Ther. 1989; 14: 58-65
- Management of chronic orthostatic hypotension.Am J Med. 1986; 80: 454-464
- Treatment of chronic orthostatic hypotension with ergotamine.Circulation. 1983; 67: 602-609
- Low bioavailability as a cause of apparent failure of dihydroergotamine in orthostatic hypotension.Br Med J. 1980; 281: 275-276
- Low bioavailability of dihydroergotamine and first-pass extraction in patients with orthostatic hypotension.Clin Pharmacol Ther. 1981; 30: 673-679
- Treatment of postural hypotension with aerosol ergotamine.Can Med Assoc J. 1988; 139: 51-52
- Assessment of autonomic function.in: Manual for House Officers. Williams and Wilkins, Baltimore1981: 86-131
- Haemodynamic effects of dihydroergotamine in patients with postural hypotension.Acta Med Scand. 1974; 196: 473-477
- Treatment of orthostatic hypotension with dihydroergotamine.Br Med J. 1979; 279: 307
- Dihydroergotamine in idiopathic orthostatic hypotension: short-term intramuscular and long-term oral therapy.Clin Pharmacol Ther. 1981; 6: 782-789
- Treatment of orthostatic hypotension with dihydroergotamine and caffeine.Ann Intern Med. 1986; 105: 168-173
- Clinical pharmacokinetics of ergotamine in migraine and cluster headaches.Clin Pharmacokinet. 1985; 10: 334-352
- Postprandial alterations in cardiovascular hemodynamics in autonomic dysfunction states.Am J Cardiol. 1981; 48: 1048-1052
- Effect of caffeine on intestinal absorption of ergotamine in man.Eur J Clin Pharmacol. 1974; 7: 213-216
- Intrinsic myocardial contractility in human autonomic failure. Assessment using pressure-volume relations (abstr).Clin Res. 1986; 34: 299A
- Angina pectoris and sudden death in the absence of atherosclerosis following ergotamine treatment for migraine.Am J Med. 1979; 67: 177-178
Accepted: August 30, 1989
Received: July 17, 1989
☆This study was supported in part by grant RR 00095 from the National Institutes of Health, Bethesda, Maryland, and a grant from the Dysautonomia Foundation, New York, New York. Preliminary results of this work were presented at the annual meeting of the American Heart Association, Washington, DC, November 14–17, 1988.
© 1990 Published by Elsevier Inc.