Droxidopa Oral Brands in India
Droxidopa (Northera) is not currently available as an oral brand in India. Based on the available evidence, there is no indication that droxidopa is marketed or approved for use in India 1, 2.
Understanding Droxidopa
Droxidopa is a synthetic amino acid precursor of norepinephrine that is primarily used for the treatment of neurogenic orthostatic hypotension (nOH). It received FDA approval in the United States in 2014 for the treatment of symptomatic nOH in adults 3.
Availability in Different Countries
The available evidence indicates that:
- In the United States, droxidopa is marketed under the brand name Northera 3
- In Japan, droxidopa is available in doses of 100-600mg TID 2
- In Malaysia, India, Singapore, Republic of Korea, and Indonesia, there is no evidence of droxidopa being available as per the clinical practice guidelines reviewed 1
Alternative Medications Available in India for Orthostatic Hypotension
For patients in India requiring treatment for neurogenic orthostatic hypotension, the following alternatives may be considered:
Midodrine: An alpha-1 adrenergic agonist (5-20mg TID) that is strongly recommended for neurogenic orthostatic hypotension 1, 2
Fludrocortisone: A salt-retaining steroid (0.1-0.3mg daily) that has a moderate recommendation for orthostatic hypotension 1, 2
Pyridostigmine: May be considered for patients refractory to other treatments (30mg 2-3 times daily) 1, 2
Non-Pharmacological Management Options
For patients in India without access to droxidopa, non-pharmacological measures are important:
- Regular exercise of leg and abdominal muscles
- Acute water ingestion (500ml, 30 minutes before anticipated orthostatic stress)
- Physical counter-pressure maneuvers (leg crossing, squatting)
- Compression garments (thigh-high compression stockings)
- Increased salt intake (6-10g daily)
- Small, frequent meals instead of large meals 2
Clinical Considerations
- Droxidopa has shown efficacy in improving symptoms of orthostatic hypotension with an NNT below 10 4
- It has demonstrated both subjective improvement in dizziness/lightheadedness and objective improvement in standing systolic blood pressure 5
- The most common side effects include headache (13.5%) and dizziness (10.1%) 5
- Supine hypertension is a potential concern with all medications for orthostatic hypotension, including droxidopa 6
Conclusion for Indian Patients
For patients in India seeking droxidopa, it is important to note that this medication is not currently available in the Indian market. Patients requiring treatment for neurogenic orthostatic hypotension should discuss alternative medications with their healthcare providers, focusing on those that are available locally such as midodrine and fludrocortisone.