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Refractory bradycardia and hypotension in patients with autonomic dysfunction treated with pseudoephedrine
  1. Caleigh Curran1,
  2. Farideh Davoudi2,
  3. Gabriel Foster3 and
  4. Patrick Gordan2
  1. 1Pharmacy, Salem Hospital, Salem, Massachusetts, USA
  2. 2Internal Medicine, Salem Hospital, Salem, Massachusetts, USA
  3. 3Cardiology, Salem Hospital, Salem, Massachusetts, USA
  1. Correspondence to Dr Patrick Gordan; PGORDAN{at}PARTNERS.ORG


We describe a man in his 40s with a history of chronic intranasal cocaine use and C5–C7 incomplete quadriplegia complicated by neurogenic orthostatic hypotension, admitted to the intensive care unit for worsening bradycardia and hypotension requiring initiation of dopamine and an increase of his home midodrine dose. The patient experienced refractory bradycardia and hypotension with weaning of dopamine, and therefore a recommendation was made to add pseudoephedrine to his current regimen. This case describes the addition of pseudoephedrine to facilitate weaning off intravenous vasopressors within 24 hours in a patient with refractory bradycardia and hypotension secondary to autonomic dysfunction.

  • Cardiovascular medicine
  • Intensive care
  • Medical management
  • Spinal cord
  • Pharmacology and therapeutics

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  • Contributors CC wrote the first draft of the manuscript and edited all subsequent versions. FD, GF and PG provided intellectual guidance, edited subsequent versions and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.