Treatment of autonomic neuropathy, postural tachycardia and orthostatic syncope with octreotide LAR
The purpose of this study was to determine whether autonomic neuropathy and the postural tachycardia syndrome can be treated with octreotide LAR (Long Acting Release). This was an open-label pilot project. Protocol 1 Patients with autonomic neuropathy (n = 4) were given increasing doses of octreotide LAR once a month for three months. Blood pressure was measured in the sitting posture every two weeks. Pretreatment mean blood pressure averaged 83.8 ± 7.1 mm Hg. After four, six and eight weeks of therapy the blood pressures averaged 96.3 ± 6.4, 98.2 ± 6.1 (p < .025), and 104.1 ± 3.1 (p < .025) respectively. Therapy led to a dramatic improvement in symptoms in one patient but another had an unacceptable elevation in supine blood pressure. Protocol 2 Patients with POTS or orthostatic intolerance were given 10, 20, or 30 mg of octreotide LAR over three months. Seven patients entered and five completed the study. After two months treatment, standing time increased from 36.0 ± 9.2 to 59.2 ± .8 minutes (p < .01). Heart rate in the standing position was suppressed from 106 ± .83 to 93.2 ± .8 beats per minute (p < .05). Orthostatic dizziness and chronic fatigue improved. We conclude that octreotide LAR can be used to treat autonomic neuropathy but there is a risk of an excessive pressor response. Octreotide LAR improved standing time and suppressed tachycardia in patients with orthostatic intolerance.
Key wordspostural tachycardia octreotide midodrine autonomic nervous system
- 4.Hoeldtke RD, D’Dorisio TM, Boden G (1987) Treatment of autonomic neuropathy with a somatostatin analogue. Lancet II 602–605Google Scholar
- 11.Sizer K (1999) Sandostatin LAR depot investigator’s brochure, Novartis Pharmaceuticals, Basel Switzerland, p 32Google Scholar
- 12.Stewart JM, McLeod KJ, Sanyal S, Herzberg G, Montgomery LD (2004) Relation of postural vasovagal syncope to splanchnic hypervolemia in adolescents. Circulation 100:2675Google Scholar
- 15.Winer BJ (1979) Statistical principles and experimental design. 2nd ed. McGraw Hill, New York pp 309–603Google Scholar