An 80-year-old female presents with recurrent falls. She has fallen a few times whilst walking to the toilet at
night to pass urine. She always feels light-headed prior to falling and denies palpitations.
She suffers from ischaemic heart disease, hypertension, diabetes mellitus, hypercholesterolaemia, osteoporosis and hypothyroidism. She is taking gliclazide, metformin, ramipril, doxazosin, levothyroxine, aspirin, simvastatin and weekly alendronate.
Her blood pressure is 130/70 mmHg and her pulse is 70 beats per minute and is irregular. She undergoes a
medication review as part of a multi-factorial risk assessment.
Which one of the following medications is most likely to be the culprit for her symptoms?
A Alendronate
B Doxazosin (Correct)
C Levothyroxine
D Metformin
E Ramipril
The patient has symptoms of postural hypotension and subsequent presyncope.
It may be possible that she has a degree of autonomic dysfunction secondary to diabetes mellitus that would
put her at even greater risk of postural hypotension with an alpha blocker. The most likely cause is the alpha
blocker doxazosin that is used for hypertension.
Answers A, C, D and E are incorrect because B, doxazocin, is most likely to cause postural hypotension.