The use of pharmacologic agents in the treatment of NCS is controversial. Fludrocortisone has been used in patients with recurrent syncope and presyncope associated with hypotension. Fludrocortisone is a mineralocorticoid agent that raises blood pressure by stimulating renal sodium and fluid retention. Side effects and treatment-limited effects include hypertension, hypokalemia, and hypomagnesemia. Fludrocortisone tends to be the first-line pharmacologic treatment for recurrent NCS, but recent data suggest that fludrocortisone is not effective at preventing NCS and is not better than placebo. The data, however, are generally limited, and it is difficult to draw conclusive recommendations.8,82
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