midodrine + atomoxetine

Midodrine + atomoxetine is a combination of two small molecule drugs used in the management of neurogenic orthostatic hypotension (nOH), particularly in patients who do not respond adequately to monotherapy. Midodrine is an alpha-1 adrenergic receptor agonist that increases vascular tone and blood pressure by causing vasoconstriction. Atomoxetine is a selective norepinephrine transporter inhibitor, increasing synaptic norepinephrine levels and thereby also raising blood pressure. Both agents are used to counteract the drop in blood pressure upon standing seen in nOH. Clinical studies have shown that while both drugs individually improve orthostatic blood pressure, combining them does not provide additional benefit over monotherapy for most patients[2][3][5]. The combination may increase the risk of hypertension and requires careful monitoring[1][6].