Byun JI, et al. - The long-term (for up to 3 months) efficacy and safety of single or combined therapy with midodrine and pyridostigmine for neurogenic orthostatic hypotension (OH) were evaluated in this study. In patients with OH, single or combination treatment with midodrine and pyridostigmine was effective and safe for up to 3 months. Compared to pyridostigmine, midodrine was better at improving OH-related symptoms.

• The researchers conducted a randomized, open-label clinical trial.
• They enrolled 87 patients with symptomatic neurogenic OH and were randomized to receive 1 of 3 treatments: midodrine only, pyridostigmine only, or midodrine + pyridostigmine.
• They followed up the patients at 1 and 3 months after treatment.
• Improvement in orthostatic blood pressure (BP) drop at 3 months were the primary outcome measures.
• The improvement of the orthostatic BP drop at 1 month and amelioration of the questionnaire score evaluating OH-associated symptoms were included as the secondary endpoints.

• At 3 months after treatment, orthostatic systolic and diastolic BP drops improved significantly in all treatment groups.
• During the 3-month treatment, orthostatic symptoms were significantly ameliorated, and the symptom severity was as follows: midodrine only < midodrine + pyridostigmine < pyridostigmine only group.
• By 11.5% of the patients, mild to moderate adverse events were reported.