Therapeutic Targets
- Avoidance of recurrence (recurrence) of syncope.
- Avoidance of secondary complications (e.g., risk of falling).
Drug recommendations [S1 Guideline 2020]
Patients with reflex syncope (neurogenic orthostatic hypotension/orthostatic hypotension):
- Medication in young patients with hypotension:
- Midodrine (alpha-1 receptor antagonist; sympathomimetic/support of peripheral vasoconstriction; midodrine is a prodrug whose metabolite desglymidodrine is the actual active ingredient) or pyridostigmine (parasympathomimetic that acts as a cholinesterase inhibitor) or
- Fludrocortisone (synthetic aldosterone analogue, which is one of the mineralocorticoids); only as short-term therapy and if physical and other measures have led to no therapeutic success.
- Elderly patients with hypertension (high blood pressure): interruption of antihypertensive (blood pressure-lowering) therapy or dose reduction until a target systolic blood pressure is reached (according to lead lines; see below Hypertension.
- In drug-induced orthostatic hypotension → readjustment (e.g., replacement of a tricyclic antidepressant with a selective serotonin reuptake inhibitor (SSRI)) or conversion of hypertensive therapy.
