Metoclopramide alone or combined with flurbiprofen in the treatment of orthostatic hypotension associated with diabetes mellitus.

Two patients with orthostatic hypotension, complicating diabetes mellitus, were treated with dopaminergic antagonist metoclopramide alone or combined with the nonsteroidal anti-inflammatory agent flurbiprofen. Both patients responded favorably to combined treatment of both drugs, with improvement of orthostatic hypotension. In one case, this improvement persisted after withdrawal of flurbiprofen on metoclopramide monotherapy. Blood volume and plasma aldosterone, norepinephrine, and epinephrine levels were unaltered during treatment with these agents. However, plasma renin activity was markedly decreased and, in one patient, exchangeable sodium was increased by 250 mmol. Metoclopramide, alone or combined with the nonsteroidal agent flurbiprofen, may be useful in the treatment of postural hypotension associated with diabetes mellitus. The favorable influence of these agents on blood pressure could not be explained by blood volume expansion or activation of the sympathetic or renin-angiotensin-aldosterone systems.