The Orthostatic Intolerance (OI) Center
Drugs, Herbs & Vitamins That Can Increase Orthostatic Symptoms
Use With Caution
Some drugs, vitamins and herbs can cause orthostatic changes and worsen orthostatic symptoms for people with OI. .
These drugs have been reported to cause orthostatic problems for normal people. On the drug label or package insert, they might have side effects listed like "orthostatic hypotension" or dizziness.
Many pharmacies now have software that will alert you or your doctors if one of your medications has an alert about using it with orthostatic conditions.
The fact that a drug has these kinds of side effects does not mean that it should never be taken by a person with OI. It does mean that the drug could increase orthostatic symptoms. It could increase how intense the symptoms are when they happen. It could also make OI symtpoms show up with the smallest of orthostatic stressors.
BUT - sometimes, one of these drugs is the best option. It can still be used with the caution. It should be started at lower doses. You will need to work closely with your physician/health professional to watch how it affects you.
It will help if you keep a diary of your OI episodes or symptoms. You are looking to see if you get them more often, if they come easier or faster, whether they are more intense. Those would be reasons to reconsider using the drug.
If you are tolerating the drug ok at the lower dose but an increase dose is needed to get the response you need, the recommendation is to increase the dose slowly and watch how it affects orthostatic symptoms. The good news/bad news is that many people with orthostatic intolerance, POTS, and CFS are more sensitive to medications and can get a positive effect from a much lower dose. This should be discussed with your physician and healing team.
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Narcotics |
Morphine, codeine, oxycodone |
Tricyclic antidepressants |
Imipramine (Tofranil), amitriptyline (Endep, Elavil), nortriptyline (Pamelor, Aventyl), phenothiazines (thorazine, Mellaril) |
Nontricyclic antidepressants (Especially in higher doses. Lower dose are often tolerated.) |
Trazodone (Desyrel), paroxetine (Paxil), venlafaxine (Effexor) |
Monoamine oxidase inhibitors |
Phenelzine (Nardil) |
Neuroleptics |
Chlorpromazine (Thorazine), quetiapine (Seroquel) |
Antihypertensive agents (Meds for high blood pressure) |
Clonidine (Catapres), labetalol (Normodyne,Trandate), verapamil (Calan, Isoptin,Verelan), captopril (Capoten), hydralazine (Apresoline) |
Nitrates |
Nitroglycerin, nitrostat, nitroquick, nitrolingual, nitro-dur, minitran, nitro-bid; isosorbide (Imdur, Ismo, Monoket) |
Diuretics |
Furosemide (Lasix) |
Antiparkinsonian agents |
Levodopa (Sinemet), bromocriptine (Parlodel), ropinirole (Requip), pramipexole (Mirapex) |
Drugs for prostatism (inflammation of the prostate) |
Prazosin (Minipress), terazosin (Hytrin) |
Drugs for erectile dysfunction |
Sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis) |
Drugs that induce autonomic neuropathy |
Amiodarone (Cordarone, Pacerone), vincristine (Oncovin, Vincasar), cisplatin (Platinol) |
Insulin |
In people with diabetes who also have autonomic failure. |
Phenothiazine anti-emetics (for nausea and vomiting) |
Phenergan, compazine |
Heart rhythm drugs (These drugs are also used to treat POTS) |
Beta blockers – metoprolol (Inderal) |
Niacin (Vitamin B3) |
This is an issue when it is used in higher doses to treat high cholesterol, which is usually over 1000 mg per day. |
References
- Figueroa JJ, Basford JR, Low PA. Preventing and treating orthostatic hypotension: As easy as A, B, C. Cleve Clin J Med. 2010 May;77(5):298-306. Abstract. Article PDF.
Author: Kay E. Jewell, MD
Page Last Updated: June 14, 2012
