Summarize:

Some medications can cause postural hypotension. Take a list of your medications to your doctor including any herbal supplements or beverages and ask whether stopping or switching your medicine might help with your symptoms. Never stop taking your medicine without your doctor’s supervision.  Common medications that cause hypotension are those that treat high blood pressure and heart problems (diuretics, alpha-blockers, beta-blockers, calcium channel blockers, ACE inhibitors, and nitrates). Sometimes lowering the dose you take can ease symptoms. Other medications that can cause hypotension as a side effect are some antidepressants and antipsychotics, drugs for Parkinson’s disease, muscle relaxants, narcotics, and medicines for erectile dysfunction. The medication fludrocortisone raises your blood pressure by increasing how much fluid there is in your blood. For severe, persistent symptoms, this medication can be helpful. See your doctor to discuss this medication, and get a prescription for it. Medications are only prescribed for chronic, i.e. persistent rather than occasional, orthostatic hypotension. This medication also increases your blood pressure, making it far less likely you’ll experience orthostatic hypotension. Remember that all medications may have side effects. Midodrine may cause you to have high blood pressure when you lie down. Discuss this risk with your healthcare provider. If a specific disease is causing your postural hypotension, then taking the right medication may help. You doctor can prescribe one of these with other medications to treat the underlying cause:  Droxidopa (Northera) is used when Parkinson’s disease causes your orthostatic hypotension. Epoetin (Epogen, Procrit) can help if the problem is due to chronic anemia. Pyridostigmine (Regonol, Mestinon) can be helpful for those with neurological problems, and unlike midodrine it doesn’t cause hypertension when you lie down.  Nonsteroidal anti-inflammatories (NSAIDs) can be used, as well, but not if you have kidney problems. Low blood sugar and diabetes can cause hypotension. If you’re diabetic, work with your doctor, endocrinologist, or diabetes nurse to keep your blood sugar in a safe range. Low blood sugar can be just as dangerous as high blood sugar, if not more so. If you’re not diagnosed as diabetic but you often have postural hypotension, discuss your symptoms with your doctor and have your blood sugar and A1C checked.
Stop taking medications that cause low blood pressure. Get a prescription for fludrocortisone (Florinef). Try midodrine (ProAmatine). Discuss other medication options with your doctor. Control your blood sugar.