Trial reportHypertension (Dallas, Tex. : 1979)2014
Efficacy of atomoxetine versus midodrine for the treatment of orthostatic hypotension in autonomic failure.
Trial report in Hypertension (Dallas, Tex. : 1979), 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 52 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Phase 2 Norepinephrine Transporter Blockade, Autonomic Failure IND117394 12/28/12
Efficacy and Safety of Midodrine and Atomoxetine Treatment in Patients With Neurogenic Orthostatic Hypotension : A Prospective Randomized Study
Who cites it
52 citing papers in PubMed, 1 synthesis or guideline pooled it, 116 citations in OpenAlex.
- Diagnosis and treatment of autonomic failure, pain and sleep disturbances in Parkinson's disease: guideline "Parkinson's disease" of the German Society of Neurology.Journal of neurology · 2025Guideline
- Atomoxetine on neurogenic orthostatic hypotension: a randomized, double-blind, placebo-controlled crossover trial.Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2024Trial
- Safety and efficacy of ampreloxetine in symptomatic neurogenic orthostatic hypotension: a phase 2 trial.Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2021Trial
- Efficacy of atomoxetine versus midodrine for neurogenic orthostatic hypotension.Annals of clinical and translational neurology · 2020Trial
- Synergistic Pressor Effect of Atomoxetine and Pyridostigmine in Patients With Neurogenic Orthostatic Hypotension.Hypertension (Dallas, Tex. : 1979) · 2019Trial
- Review
- Review
- Misconceptions and Facts About Orthostatic Hypotension.The American journal of medicine · 2025Review
- Orthostatic hypotension in Parkinson's disease: therapeutic considerations.Therapeutic advances in neurological disorders · 2025Review
- Update on the Treatment of Autonomic Disorders.Current treatment options in neurology · 2025Article
- Advances in autonomic dysfunction research in Parkinson's disease.Frontiers in aging neuroscience · 2025Review
- Oral blood pressure augmenting agents for intravenous vasopressor weaning.World journal of clinical cases · 2024Review
- Norepinephrine Reuptake Inhibition, an Emergent Treatment for Neurogenic Orthostatic Hypotension.Hypertension (Dallas, Tex. : 1979) · 2024Review
- Atomoxetine for Intradialytic Hypotension in a Patient on Hemodialysis: A Case Report.Kidney medicine · 2024Article
- Non-pharmacological and drug treatment of autonomic dysfunction in multiple system atrophy: current status and future directions.Journal of neurology · 2023Review
- Symptomatic Care in Multiple System Atrophy: State of the Art.Cerebellum (London, England) · 2023Review
- Effects of Atomoxetine for the Treatment of Neurogenic Orthostatic Hypotension in Patients With Alpha-synucleinopathies: A Systematic Review of Randomized Controlled Trials and a Focus-Group Discussion.Journal of clinical neurology (Seoul, Korea) · 2023Article
- Orthostatic Hypotension in Multiple System Atrophy: Related Factors and Disease Prognosis.Journal of Parkinson's disease · 2023Article
- Updates on the Diagnosis and Treatment of Peripheral Autonomic Neuropathies.Current neurology and neuroscience reports · 2022Review
- New horizons in the ageing autonomic nervous system: orthostatic hypotension and supine hypertension.Age and ageing · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors at 1 institution in 1 country.
Funding
Abstract
The clinical presentation of autonomic failure is orthostatic hypotension. Severely affected patients require pharmacological treatment to prevent presyncopal symptoms or frank syncope. We previously reported in a proof of concept study that pediatric doses of the norepinephrine transporter blockade, atomoxetine, increases blood pressure in autonomic failure patients with residual sympathetic activity compared with placebo. Given that the sympathetic nervous system is maximally activated in the upright position, we hypothesized that atomoxetine would be superior to midodrine, a direct vasoconstrictor, in improving upright blood pressure and orthostatic hypotension-related symptoms. To test this hypothesis, we compared the effect of acute atomoxetine versus midodrine on upright systolic blood pressure and orthostatic symptom scores in 65 patients with severe autonomic failure. There were no differences in seated systolic blood pressure (means difference=0.3 mm Hg; 95% confidence [CI], -7.3 to 7.9; P=0.94). In contrast, atomoxetine produced a greater pressor response in upright systolic blood pressure (means difference=7.5 mm Hg; 95% CI, 0.6 to 15; P=0.03) compared with midodrine. Furthermore, atomoxetine (means difference=0.4; 95% CI, 0.1 to 0.8; P=0.02), but not midodrine (means difference=0.5; 95% CI, -0.1 to 1.0; P=0.08), improved orthostatic hypotension-related symptoms as compared with placebo. The results of our study suggest that atomoxetine could be a superior therapeutic option than midodrine for the treatment of orthostatic hypotension in autonomic failure.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.