Abstract：
BACKGROUND: Pyridostigmine is hypothesized to improve neurogenic orthostatic hypotension (nOH) symptoms without causing or exacerbating supine hypertension. The objective of this review was to evaluate the safety and efficacy of pyridostigmine for management of nOH.
METHODS: A literature search of PubMed, Embase, and CENTRAL was performed in December 2023 for prospective trials with a placebo or active comparator.
RESULTS: Four randomized and two non-randomized studies were reviewed. Three studies utilizing a single dose, crossover design found significant differences of orthostatics using adjunctive pyridostigmine. Two studies assessing longer-term endpoints demonstrated conflicting efficacy of pyridostigmine with one trial finding significant improvement in orthostatics and symptoms after three months of therapy. Use of pyridostigmine did not lead to supine hypertension with most adverse effects being cholinergic.
CONCLUSIONS: Pyridostigmine may be considered as an adjunctive medication in individuals with nOH refractory to standard treatment options as it carries a favorable safety profile with low risk for supine hypertension.
METHODS: A literature search of PubMed, Embase, and CENTRAL was performed in December 2023 for prospective trials with a placebo or active comparator.
RESULTS: Four randomized and two non-randomized studies were reviewed. Three studies utilizing a single dose, crossover design found significant differences of orthostatics using adjunctive pyridostigmine. Two studies assessing longer-term endpoints demonstrated conflicting efficacy of pyridostigmine with one trial finding significant improvement in orthostatics and symptoms after three months of therapy. Use of pyridostigmine did not lead to supine hypertension with most adverse effects being cholinergic.
CONCLUSIONS: Pyridostigmine may be considered as an adjunctive medication in individuals with nOH refractory to standard treatment options as it carries a favorable safety profile with low risk for supine hypertension.
摘要：
背景：假设吡啶斯的明可以改善神经源性直立性低血压（nOH）症状，而不会引起或加剧仰卧位高血压。本综述的目的是评估吡啶斯的明用于治疗nOH的安全性和有效性。
方法：PubMed的文献检索，Embase,CENTRAL于2023年12月进行了安慰剂或活性对照品前瞻性试验.
结果：对4项随机和2项非随机研究进行综述。三项使用单剂量的研究，交叉设计发现使用辅助吡啶斯的明的正位学存在显着差异。两项评估长期终点的研究表明，吡啶斯的明的疗效相互矛盾，一项试验发现，治疗三个月后，矫正器和症状显着改善。使用吡啶斯的明不会导致仰卧位高血压，大多数不良反应是胆碱能。
结论：吡唑斯的明可被视为标准治疗方案难以治疗的nOH患者的辅助药物，因为它具有良好的安全性和仰卧位高血压的低风险。
方法：PubMed的文献检索，Embase,CENTRAL于2023年12月进行了安慰剂或活性对照品前瞻性试验.
结果：对4项随机和2项非随机研究进行综述。三项使用单剂量的研究，交叉设计发现使用辅助吡啶斯的明的正位学存在显着差异。两项评估长期终点的研究表明，吡啶斯的明的疗效相互矛盾，一项试验发现，治疗三个月后，矫正器和症状显着改善。使用吡啶斯的明不会导致仰卧位高血压，大多数不良反应是胆碱能。
结论：吡唑斯的明可被视为标准治疗方案难以治疗的nOH患者的辅助药物，因为它具有良好的安全性和仰卧位高血压的低风险。
