Vasovagal syncope: an update on the latest pharmacological therapies.
INTRODUCTION
Syncope is an abrupt loss of consciousness in response to reduced perfusion to the brain. Neurocardiogenic or vasovagal syncope results from a complex neurologic reflex, and treatments to prevent recurrence attempt to modulate aspects of that reflex.


AREAS COVERED
Pharmacologic treatments for vasovagal syncope address the syncope reflex in multiple ways. Fludrocortisone and sodium chloride increase systemic fluid volume. Midodrine, β blockers and norepinephrine transport inhibitors modulate the sympathetic nervous system. Other treatments for syncope modulate other neurotransmitters or affect heart rate. The most recent trials evaluating established and novel therapies are reviewed.


EXPERT OPINION
To reduce recurrence of vasovagal syncope, conservative measures are first line. If these fail to prevent recurrence, the most promising medical therapy includes midodrine. Randomized placebo-controlled data evaluating fludrocortisone, midodrine and β blockers in older patients are awaited. Because of the significance of the placebo effect in this condition, any treatment must be evaluated in a randomized double-blind placebo-controlled trial before being accepted as effective.
['Schleifer|John William|JW|', 'Shen|Win-Kuang|WK|']
D002986:Clinical Trials as Topic D006339:Heart Rate D006801:Humans D018377:Neurotransmitter Agents D010275:Parasympathetic Nervous System D017410:Practice Guidelines as Topic D013564:Sympathetic Nervous System D019462:Syncope, Vasovagal D014882:Water-Electrolyte Balance
vasovagal syncope neurocardiogenic fludrocortisone midodrine β blockers autonomic