When a person moves from lying down to standing, sometimes their blood pressure will suddenly drop and they will feel lightheaded. This is called orthostatic hypotension and is common in people with Parkinson's disease. Orthostatic hypotension can be severe in people with certain forms of the disease. Orthostatic hypotension can be caused by the disease itself or by the medications used to treat Parkinson's disease. Almost any of the commonly prescribed Parkinson's disease drugs can cause or worsen lightheadedness.
How Is Orthostatic Hypotension Diagnosed?
If you are experiencing lightheadedness after standing and think you might have orthostatic hypotension, call your doctor so that you can be evaluated. Your doctor should check your blood pressure when you are lying down, seated and then again when standing up.
When Is Orthostatic Hypotension Treated?
Not all forms of orthostatic hypotension require treatment. If you experience a drop in blood pressure when you stand up, but have no other symptoms you probably won't need treatment. Sometimes all it takes is sitting on the edge of the bed for a minute or steadying yourself for a moment after you stand up. But, if you feel dizzy or lightheaded to the point where you might lose your balance or lose consciousness, you will need treatment.
Because some drugs can cause severe orthostatic hypotension, your doctor may first try reducing some of your medicine or may switch you to another type of medicine. If you have significant symptoms of orthostatic hypotension, and it is not possible to change your medications, then your doctor will likely treat the orthostatic hypotension itself.
How Is Orthostatic Hypotension Treated?
Droxidopa (Northera). fludrocortisone (Florinef), or midodrine (ProAmatine) capsules are approved for the treatment of orthostatic hypotension. Common side effects include headache, dizziness, nausea, high blood pressure, and fatigue.
Another approach in treating orthostatic hypotension is to decrease the pooling of blood in the legs with the use of special stockings called compression stockings. These tight stockings "compress" the veins in the legs, helping to reduce swelling and increase blood flow. There are a number of companies that make these stockings in a wide variety of sizes, and they usually can be found at stores that sell medical supplies, as well as at some pharmacies.
You should wear these stockings when you are up and about. You do not need to wear them when you are in bed. Further, it is recommended that you put the stockings on first thing in the morning while in bed and before getting up for your daily activities. It is important that you do not let the stockings bunch, gather, or roll, since this can compress the veins too much and could harm circulation. You should always watch for signs of decreased circulation, which could include discoloration of the skin, as well as pain or cramping, and numbness of the lower legs and feet.
If the stockings only provide some but not complete relief of symptoms, an abdominal binder can be used. The binder is another type of compression garment that is worn around the waist to help increase blood pressure. If these products fail to alleviate symptoms, certain drugs like florinefcan be given to help increase blood volume. If you are taking these drugs, be sure to watch for signs of too much fluid in the body, such as swelling, bloating, or difficulty breathing. If these symptoms occur, call your doctor immediately.