Pharmacological Interventions for Orthostatic Hypotension

Studies addressing the pharmacological management of OH in acute SCI to date are limited. Only one study was found which investigated midodrine hydrochloride as treatment for OH in acute SCI patients, as well, the effectiveness of midodrine hydrochloride for acute OH has also been studied in case report format (Barber et al. 2000; Mukand et al. 2001). There have been several more pharmacological agents studied in the chronic SCI population, including fludrocortisone, dihydroergotamine, ephedrine, L-threo-3,4-dihydroxyphenylserine (LDOPS), nitro-L-arginine methyl ester (L-NAME), although little evidence exists regarding their use for OH in chronic SCI (refer to SCIRE Orthostatic Hypotension rehabilitation evidence chapter).

Pharmacological Management of Orthostatic Hypotension during Acute SCI


There has been one study to investigate the pharmacological management of OH during acute SCI. Phillips et al. (2014) conducted a RCT examining the effectiveness of midodrine for OH. The study was comprised of 10 SCI patients, the majority of which had acute injuries (6.5-11 weeks after injury). It should be noted that this study did also include two patients with chronic SCI who were 144-324 weeks after injury. Patients were subjected to a tilt-table procedure in which they were progressively tilted from supine position to 30°, 45°, and 60° angles. This procedure was conducted over two days, during which the SCI patients were randomly assigned to receive 10 mg of midodrine orally, or no treatment (baseline measure). Improvement in orthostatic tolerance was observed in 59% of patients who received midodrine; this was a significant improvement compared to those who received no treatment (p<0.01).


There is level 2 evidence (from one RCT cross-over; Phillips et al. 2014) that midodrine hydrochloride leads to improved orthostatic tolerance in acute SCI patients.

  • Midodrine hydrochloride may be effective for the management of orthostatic hypotension during the acute phase post SCI.