midodrine + pyridostigmine

Midodrine + pyridostigmine is a combination therapy used primarily for the management of neurogenic orthostatic hypotension (OH). Midodrine is an alpha-1 adrenergic agonist that increases vascular tone and raises blood pressure by causing vasoconstriction. Pyridostigmine is a cholinesterase inhibitor that enhances cholinergic neurotransmission in autonomic ganglia, thereby improving sympathetic outflow and increasing blood pressure, particularly in the upright posture. The combination aims to provide additive or synergistic effects on improving orthostatic blood pressure without significantly worsening supine hypertension. Clinical studies have shown that this combination can be effective and safe for up to three months, with improvements in both systolic and diastolic orthostatic BP drops as well as amelioration of OH-related symptoms[1][2][3][6][7].