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May 3, 2006

Akathisia With Combined Use of Midodrine and Promethazine

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2006;295(17):1997-2001. doi:10.1001/jama.295.17.2000-b

To the Editor: Midodrine is commonly prescribed for treatment of orthostatic hypotension.1 We have been studying its use as a pharmacological countermeasure for post-spaceflight orthostatic hypotension because it is fast acting and has no known cardiac or central adverse effects.1 Promethazine is the antiemetic of choice by National Aeronautics and Space Administration (NASA) flight surgeons for the treatment of postflight nausea and vomiting. Because midodrine and promethazine would likely be used together on landing day, we studied whether promethazine would counteract the positive effects of midodrine on orthostatic tolerance. In the course of that study, we observed an unexpected degree of akathisia.