As a paramedic you will need to check your scope of practice regarding drug treatments. For instance, in some jurisdictions, a Primary Care Paramedic can administer nitrites, but not for the treatment of AD.


Treatment guidelines are derived from consensus reports. There are no prospective randomized controlled trials.

An ideal agent for treatment includes:

  • Rapid onset with short duration of action
  • Few side effects
  • Prevents recurrence

Acute AD Drug Treatment
Click the heading for information.

First line Therapy…

Ca2+ channel blockers

  • Nifidepine: 10 mg s/l q 30 mins to abort attack

ACE inhibitors

  • Captopril:12.5-25 mg s/l or po (25mg equiv Nifedipine 10 mg) – onset 5-10 mins s/l, 15-30 mins po Ace

Direct arterial dilators

  • Nitrates: transdermal, remove if hypotensive, s/e headache – IV in severe AD

For more details on management of AD see:

  • Krassioukov A, Warburton DER, Teasell RW, Eng JJ (2010). Autonomic Dysreflexia Following Spinal Cord Injury. In: Spinal Cord Injury Rehabilitation Evidence. Version 3.0. Vancouver: p 1-33.
  • Krassioukov A, Warburton DE, Teasell R, Eng JJ; Spinal Cord Injury Rehabilitation Evidence Research Team. A systematic review of the management of autonomic dysreflexia after spinal cord injury. Arch Phys Med Rehabil. 2009 Apr;90(4):682-95.


Click on the video below to view a testimonial regarding treatment of AD.