Shy-Drager Syndrome Treatments

Medication

Options may include:

• Drugs to prevent drops in blood pressure, including:
  • Fludrocortisone (Florinef)
  • Indomethacin (Indocid)
  • Midodrine (ProAmatine)
  • Beta blockers such as:
    • Propranolol (Inderal)
    • Pindolol (Sectral)
• Drugs that treat symptoms of Parkinson's disease such as carbidopa/levodpa.
• Laxatives or stool softeners to treat constipation
• Drugs to treat urinary symptoms, including oxybutynin, tolterodine, or propantheline—However, these can cause worsening of the constipitation.
• Drugs to treat impotence, such as yohimbine or sildenafil—Sildenafil must be used with care as it can worsen the low blood pressure that occurs with the disease, causing dizziness and fainting.

Self-care

Diet and exercise guidelines include:

• Increase salt and fluid to help keep blood pressure up when standing.
  • One recent study demonstrated that drinking about 12 ounces of tap water once daily in the early morning can decrease otherwise difficult to treat low blood pressure in multiple system atrophy.
• Drink beverages containing caffeine after meals.
• Eat small, frequent meals.
• Eat soft foods, which may be easier to swallow.
• Increase fiber to help with constipation. Avoid straining when going to the bathroom.
• Avoid drinking alcoholic beverages.
• Exercise only moderately. Avoid vigorous exercise.

Lifestyle modifications include:

• Sleep with the head of your bed raised to help prevent drops in blood pressure when arising.
• Get up slowly and change positions slowly.
• Wear elastic support stockings and abdominal binders or a body suit to help maintain blood pressure.
• Avoid too much heat in your home (including when bathing) or environment.

To help you manage specific symptoms and side effects:

• Try speech therapy for help dealing with swallowing and speech problems.
• If swallowing is a problem, ask your doctor about tube feedings.
• Join a support group for patients and/or family members.
• Ask your doctor about a penile implant and other treatments for impotence.
• Ask your doctor about intermittent catheterization for urinary problems.
• Ask your doctor before taking any drugs. Many patients with Shy-Drager syndrome are very susceptible to drug side effects even at low doses.

Breathing Support

If you have severe breathing problems that cannot be relieved in other ways, your doctor may advise that you have a tracheostomy. This is a surgically-created hole in the windpipe, usually a treatment of last resort.