ABSTRACT
Autonomic dysreflexia (AD) is a frequent, dangerous, and avoidable complication found in patients with spinal cord injury (SCI) at T6 or above characterized by sudden spikes in blood pressure. However, the consortium does not preferentially identify any particular medication for acute AD management. Nitrates are the most commonly used agents in the management of AD in individuals with SCI; however, there are no clinical studies supporting the use of nitrates in the acute management of AD post-SCI, only expert opinions. There is one randomized controlled trial that showed that prazosin is superior to placebo in the prophylactic management of AD. In addition, there have been reports on use of beta-blockers, mecamylamine, and hydralazine (Apresoline) for the general management of AD symptoms in individuals with SCI. The ability to wipe off transdermal nitrates once the AD has been treated, and thus potentially avoid secondary hypotension, is one reason many practitioners prefer transdermal nitrates as their initial therapy for acute AD episode.
