Efficacy of atomoxetine versus midodrine for neurogenic orthostatic hypotension

Jung Ick Byun, Do Yong Kim, Jangsup Moon, Hye Rim Shin, Jun Sang Sunwoo, Woo Jin Lee, Han Sang Lee, Kyung Il Park, Soon Tae Lee, Keun Hwa Jung, Ki Young Jung, Manho Kim, Sang Kun Lee, Kon Chu

Research output: Contribution to journalArticle

3 Scopus citations


Objective: The efficacy and safety of 1-month atomoxetine and midodrine therapies were compared. Three-month atomoxetine and combination therapies were investigated for additional benefits. Methods: This prospective open-label randomized trial included 50 patients with symptomatic neurogenic orthostatic hypotension (nOH). The patients received either atomoxetine 18 mg daily or midodrine 5 mg twice daily and were evaluated 1 and 3 months later. Those who still met the criteria for nOH at 1 month received both midodrine and atomoxetine for an additional 2 months, and if not, they continued their initial medication. The primary outcome was an improvement in orthostatic blood pressure (BP) drop (maximum BP change from supine to 3 min after standing) at 1 month. The secondary endpoints were symptom scores, percentage of patients with nOH at 1 and 3 months. Results: Patients with midodrine or atomoxetine treatment showed comparative improvement in the orthostatic BP drop, and overall only 26.2% of the patients had nOH at 1 month, which was similar between the treatment groups. Only atomoxetine resulted in significant symptomatic improvements at 1 month. For those without nOH at 1 month, there was additional symptomatic improvement at 3 months with their initial medication. For those with nOH at 1 month, the combination treatment resulted in no additional improvement. Mild-to-moderate adverse events were reported by 11.6% of the patients. Interpretation: One-month atomoxetine treatment was effective and safe in nOH patients. Atomoxetine improved orthostatic BP changes as much as midodrine and was better in terms of ameliorating nOH symptoms.

Original languageEnglish
Pages (from-to)112-120
Number of pages9
JournalAnnals of Clinical and Translational Neurology
Issue number1
StatePublished - 1 Jan 2020

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