A patient responding to combined therapy with pirmenol and midodrine for refractory neurally mediated syncope complicated by prostatic hypertrophy.

Yukio Mizuguchi, Takeo Ishimoto, Norihito Kageyama, Yoshifumi Oishi, Shigefumi Emi, Norio Nagase, Takashi Oki

Cardiovascular Section, Higashi Tokushima National Hospital, National Hospital Organization, 1-1 Ohmukai-Kita, Ohtera, Itano, Tokushima 779-0193, Japan. mizuguchi@higasitokusima.hosp.go.jp

Cardiovascular drugs and therapy / sponsored by the International Society of Cardiovascular Pharmacotherapy 2004 Sep

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A 67-year-old man with neurally mediated syncope (NMS) complicated by prostatic hypertrophy responded well to combined therapy with pirmenol and midodrine. In 2003, syncope occurred while the patient was driving a car. Results of head-up tilt-table testing (HUT) suggested a mixed type of NMS. Oral administration of disopyramide provided severe urinary obstruction. Pirmenol treatment was not associated with syncope during ordinary HUT, but nausea, sweating, and syncope occurred during HUT with provocative administration of isosorbide dinitrate. Combined therapy with pirmenol and midodrine avoided syncope during HUT, and has prevented attacks since discharge from the hospital.

Citation

Yukio Mizuguchi, Takeo Ishimoto, Norihito Kageyama, Yoshifumi Oishi, Shigefumi Emi, Norio Nagase, Takashi Oki. A patient responding to combined therapy with pirmenol and midodrine for refractory neurally mediated syncope complicated by prostatic hypertrophy. Cardiovascular drugs and therapy / sponsored by the International Society of Cardiovascular Pharmacotherapy. 2004 Sep;18(5):405-8