Norepinephrine Transporter Blockade, Autonomic Failure

Inclusion Criteria:

- Neurogenic Orthostatic Hypotension (defined by a reduction of ≥30 mmHg drop in SBP
within 3 minutes of standing, associated with impaired autonomic reflexes as assessed
by autonomic function tests.

Exclusion Criteria:

- Pregnancy or breastfeeding

- Hypersensitivity to atomoxetine (severe allergic reaction, rash, urticaria,
anaphylaxis)

- Use of other norepinephrine transporter inhibitors such as Wellbutrin (Bupropion),
Cymbalta (Duloxetine), Effexor (venlafaxine), Pristiq (desvenlafaxine), Savella
(milnacipran)

- Previous history (within 14 days prior to enrollment) and current use of monoamine
oxidase inhibitors

- Concomitant use of strong CYP2D6 inhibitors such as delavirdine, paroxetine,
fluoxetine, quinidine

- Pre-existing sustained severe hypertension (BP 140/80 mmhg in the sitting position)

- Impaired hepatic function (aspartate amino transaminase [AST] and/or alanine amino
transaminase [ALT] >2 x upper limit of normal range)

- Impaired renal function (serum creatinine equal or more than 1.6 mg/dl)

- Myocardial infarction within 6 months prior to enrollment

- Congestive heart failure (LV hypertrophy acceptable)

- History of serious neurologic disease such as cerebral hemorrhage, or stroke

- Inability to comply with the protocol, e.g., uncooperative attitude, inability to
return for follow-up visits, unlikelihood of completing the study, and mental
conditions rendering the subject unable to understand the nature, scope, and possible
consequences of the study

- Patients with narrow angle glaucoma

- Patients with or a history of pheochromocytoma