Effect of prenalterol on orthostatic hypotension in the Shy-Drager syndrome.

Treatment of idiopathic orthostatic hypotension is often unsatisfactory. A patient with the Shy-Drager syndrome, in which the most important symptom is orthostatic hypotension, was treated with prenalterol, initially 30 mg six times daily. The dosage was reduced to 30 mg four times daily because of the development of complex ventricular premature beats. Orthostatic symptoms were reduced and standing blood pressure increased. Fludrocortisone 0.5 mg a day was added to treatment with further improvement. This clinical effect was maintained throughout 12 months of follow up, during which the treatment was continued unchanged. Prenalterol was effective in reducing orthostatic symptoms in this patient. Further studies in patients with a similar haemodynamic pattern are indicated.