# Atomoxetine for Intradialytic Hypotension in a Patient on Hemodialysis: A Case Report

## TL;DR

A patient with severe low blood pressure during hemodialysis improved after being treated with low-dose atomoxetine.

## Contribution

This case report suggests atomoxetine as a potential treatment for intradialytic hypotension.

## Key findings

- The patient's blood pressure and symptoms improved after starting atomoxetine.
- Previous treatments like fludrocortisone and norepinephrine had limited or temporary effects.
- Atomoxetine was well-tolerated and led to sustained clinical improvement.

## Abstract

Intradialytic hypotension significantly affects patient safety and clinical outcomes during hemodialysis. Despite various pharmacological and nonpharmacological interventions, effective management remains elusive. In this report, we detail a case of intradialytic hypotension in a male patient in his 40s, undergoing hemodialysis with a history of polycystic kidney disease. Eight years ago, the patient underwent bilateral nephrectomy because of a severe cystic infection, after which his systolic blood pressure (BP) persistently remained at 50-70 mm Hg during dialysis sessions. The initial treatment strategy for hypotension included fludrocortisone, midodrine, and prednisolone, leading to a slight temporary increase in BP, which subsequently declined. As the patient’s condition deteriorated, the administration of norepinephrine or dopamine became necessary to sustain BP during dialysis. Given the patient’s resistance to these treatments, a daily dose of 25 mg of atomoxetine was introduced. Following this treatment, there was a gradual improvement in the patient’s vertigo, weakness, and BP. This case illustrates that low-dose atomoxetine can alleviate symptoms and elevate BP in patients experiencing severe intradialytic hypotension during hemodialysis.