Examples of medications that may cause or exacerbate orthostatic hypotension

Drug group	Mechanism of hypotension and comments
Diuretics Loop diuretics (eg, furosemide, torsemide) or thiazides	Extracellular fluid volume depletion.
Adrenergic antagonists
Alpha-1-adrenergic blockers (eg, alfuzosin, tamsulosin, terazosin)	Alpha-1-adrenergic blockers produce vasodilation via direct effect in vascular smooth muscle.
Beta-adrenergic blockers (eg, propranolol)	Beta-adrenergic blockers reduce cardiac output and renin release. May also reduce vascular peripheral resistance.
Alpha-2-adrenergic agonists (eg, tizanidine, clonidine)	Vasodilation via central inhibition of sympathetic efferent activity.
Nitric oxide-mediated vasodilators Nitroglycerin, hydralazine Phosphodiesterase-5-inhibitors (eg, sildenafil)	Vasodilation via direct effect in vascular smooth muscle.
Renin-angiotensin system (RAS) inhibitors (eg, lisinopril, valsartan)	Vasodilation via RAS inhibition.
Calcium-channel blockers (eg, verapamil, diltiazem)	Reduction of cardiac output, vasodilation via direct effect in vascular smooth muscle.
Dopamine antagonists Phenothiazines (eg, chlorpromazine) Atypical antipsychotics (eg, olanzapine, risperidone, quetiapine)	Vasodilation via central inhibition of sympathetic efferent activity.
Antidepressants (eg, trazodone, amitriptyline)	Vasodilation via central and peripheral inhibition of sympathetic efferent activity through stimulation of adrenergic receptors.
Selective serotonin receptor reuptake inhibitors (eg, paroxetine)	Unknown mechanism, possibly via central and peripheral inhibition of sympathetic efferent activity through stimulation of alpha-2-adrenergic receptors.
Sodium-glucose co-transporter 2 inhibitors (eg, empagliflozin, canagliflozin)	Volume depletion via osmotic diuresis.

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Examples of medications that may cause or exacerbate orthostatic hypotension