What is the next best step for treating a patient with orthostatic hypotension due to metoprolol?

In the case of orthostatic hypotension resulting from the use of metoprolol, lowering the dose of the medication may be the most appropriate initial step. Metoprolol is a beta-blocker commonly used for managing hypertension and other cardiovascular conditions. However, it can also lead to side effects such as hypotension, particularly when starting or increasing the dose.

By reducing the dose of metoprolol to 25 mg twice daily, you can help mitigate the risk of further lowering the blood pressure while still providing some level of beta-blockade for the patient’s underlying condition. This approach allows for better tolerance of the medication without abrupt withdrawal, which could lead to rebound effects such as increased heart rate or blood pressure.

Other options may involve different pharmacotherapies directed at managing orthostatic hypotension, such as starting midodrine or droxidopa; these could be considered if reducing the metoprolol dose does not adequately address the patient's symptoms. However, initiating a new medication requires careful consideration and monitoring, as it introduces additional therapy without first trying to adjust the current medication. Discontinuing all antihypertensive medications might be too drastic and could leave the patient without adequate blood pressure control. Therefore, adjusting the