Objective: To assess the long-term efficacy and safety of pyridostigmine and midodrine in the treatment of OH in PD.

Background: In  Parkinson’s  disease  (PD),  orthostatic  hypotension  (OH)  is  a  prevalent occurrence.  Pyridostigmine  and  midodrine  haven’t  been  thoroughly  investigated  as treatments for these people.

Method: Between  July  2021  and  December  2021,  a  randomized,  open- label  clinical  research  was  undertaken.  Thirteen  PD  patients  with  OH  were  randomly assigned to take either pyridostigmine or midodrine for one month. The primary outcome was a reduction in OH, with secondary outcomes included changes in orthostatic heart rate (HR),  supine  blood  pressure  (BP),  and  supine  HR,  as  well  as  the  percentage  of  patients fulfilling BP criteria for OH.

Results: At one month, both groups’ orthostatic BP had improved. Orthostatic systolic BP (SBP) drop was significantly reduced in pyridostigmine group (p < 0.001) with significant degree compared to midodrine group (-6.43 mmHg, -19 mmHg, p = 0.022). In both groups, there was no significant difference in orthostatic HR change, supine SBP change, or supine HR  change.  Two  patients  reported  mild  adverse  effects.  None  of  the  pyridostigmine patients fulfilled the BP criterion for OH, whereas 33.3 percent of the midodrine patients did.

Conclusion: Pyridostigmine and midodrine were found to be safe in OH patients with PD and  reduced  OH  following  treatment.  Pyridostigmine  was  found  to  be  superior  than midodrine  in  terms  of  improving  orthostatic  SBP  change  and  lowering  the  number  of patients who met the BP criterion for OH.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-randomized-controlled-trial-comparing-the-efficacy-and-safety-of-pyridostigmine-versus-midodrine-for-the-treatment-of-orthostatic-hypotension-in-parkinsons-disease-patients/