Flortinef and low blood pressure

: Causes of dizzinness : PD medication or supplements?

I am confused. Lately I have dizzinness all the times after I have T.I.A (Blood Clot) recently.I have done my MRI, ECG, Heart, ENT screening by neuroglist, cardiologist and otoringologist and are fine. My neurologist told me it is the sideeffect of the PD medication that lowering your blood level. He wrote me the following :- "I am glad that your dizziness has subsided. Dizziness is a very common symptom among Parkinson's patients. It needs extensive work-up, e.g. blood pressure, heart rhythm, blood tests (diabetes) and even brain scan. A common cause of dizziness among Parkinson's patients is the medications for PD, which can lower the blood pressure. Commonly, I use fludrocortisone to elevate the blood pressure. Parkinson's patients need regular blood pressure monitoring (lying position and standing). Dr Chew Nee Kong". However, after I have stopped taking my supplements my dizzinness are subsided and gone. I worry that the dizzinness would come again as there are two different diagnosis of the syndrome. My nutritionist told me: The symptoms you had got such as low blood pressure, dry mouth, insomnia and fatigue are not related to supplements , but you can reduce the dose as to take one pack per day for a while if the symptoms still going on. My question is this : Is the cause of my dizziness the result of my PD medication or is it the cause of my supplements, or both? Should my neurologist have prescribed me fludrocortisone (as claimed by him) upfront, to counter the possible effect of dizziness due to side effect of lowering of blood pressure? Kindly advise.
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Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Sat May 03, 2008 11:50 am Post subject:

Thank you for the question. My approach is to do one thing at a time. If you do one thing at a time, like stop the dopamine agonist and the dizziness subsides then you have your answer. Low blood pressure can be a symptom of PD and be worsened by PD meds. I always suggest 6-8 glasses of water a day, and sometimes compression stockings. In more severe cases after simplifying meds and eliminating other causes I may turn to midodrine or florinef and/or tensilon. You may speak to your doc about the above._________________Michael S. Okun, M.D.
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Anonymous
Posted: Sun May 04, 2008 8:06 am Post subject:

Dear Mr Teo Ropinirole and other dopamine agonists are good medications for PD, especially in the early stage. I have many patients who have done well with dopamine agonists monotherapy. However, till today, there is no ideal medication for PD. Even dopamine agonists (or any other PD medications) can cause a drop in blood pressure (postural hypotension), which causes dizziness and fainting attacks. Hope that the fludrocortisone that i prescribed you today will help bring up your blood pressure back to normal. Dr Chew Nee Kong, Kuala Lumpur. Posted by Hero Teo at 2:23 PM
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Anonymous
Posted: Tue May 06, 2008 2:25 am Post subject:

I agree with Dr.Chew that Ropinirole and other dopamine agonists are good medications for PD, especially in the early stage. Many patients who have done well with dopamine Though fludrocortisone will help some patients who has problem with dopamine agonists that lowering blood pressure and bring back pressure to normal but it causes me with dizzinness as I have irregular blood pressure level. Kindly advise Teo Kim Hoe
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Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Tue May 06, 2008 8:40 am Post subject:

My best advice is to meet with your doctor and honestly tell him or her your issues and together you can choose a plan that is best for you. Good luck._________________Michael S. Okun, M.D.
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Anonymous
Posted: Tue May 06, 2008 12:08 pm Post subject:

Thnk you for your advise. My Highest Blood pressure level is 201/95 and lowing down to 160/85 level with Florinef. Is it caused by anxiety as told by my doctor? I have stopped taking the Fludrocortisone as agreed by my doctor.
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Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Tue May 06, 2008 6:32 pm Post subject:

Thanks for the post, we will leave the decisions as to cause and treatment to your doctor and wish you well._________________Michael S. Okun, M.D.
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