Orthostatic Hypotension due to Diabetic Autonomic Neuropathy? Treatment With Domperidone

To the Editor.  —Orthostatic hypotension (OH) during diabetic autonomic neuropathy is frequent, treated with difficulty,¹ and associated with a high death rate.² Recently, indomethacin therapy has been proposed, but it is not devoid of side effects and exposes patients who already have a high risk of vascular diseases to clinostatic hypertension and coronary vasocon-striction.³ Metoclopramide dichlorhydrate therapy has been used with success in a case of severe OH after an extensive sympathectomy.⁴ Therapy with metoclopramide has frequent side effects, however.⁵ Domperidone, which antagonizes dopaminergic transmission, does not cross the blood-brain barrier⁶ and, theoretically, would be more easily tolerated. Therefore, we decided to treat a patient with diabetic OH by domperidone therapy.

Report of a Case.  —In November 1982, ketoacidosis diabetes was discovered in a 70-year-old woman with bilateral cataract, arthritis in her lower limbs, and ulceration of the soles of her feet.Blood