From the Guidelines
Droxidopa plays a beneficial role in treating neurogenic orthostatic hypotension, particularly in patients with Parkinson disease, pure autonomic failure, and multiple system atrophy.
Key Points
- Droxidopa improves symptoms of neurogenic orthostatic hypotension (OH) by increasing standing blood pressure, and may reduce falls according to small studies 1.
- The use of droxidopa may be limited by supine hypertension, headache, dizziness, and nausea, and its effectiveness may be decreased by carbidopa in patients with Parkinson disease 1.
- Droxidopa is one of several treatment options for neurogenic OH, including midodrine, fludrocortisone, and pyridostigmine, and the choice of treatment should be individualized based on patient characteristics and comorbidities 1.
- In patients with cardiac involvement or restrictive physiology, droxidopa and other medications may be poorly tolerated, and alternative treatments such as pyridostigmine or compression garments may be considered 1.
- Increased salt and fluid intake, as well as compression garments, may also be beneficial in managing neurogenic OH, but the long-term effects of these treatments are unknown 1.
From the FDA Drug Label
Droxidopa capsules are indicated for the treatment of orthostatic dizziness, lightheadedness, or the “feeling that you are about to black out” in adult patients with symptomatic neurogenic orthostatic hypotension (nOH) caused by primary autonomic failure (Parkinson's disease [PD], multiple system atrophy, and pure autonomic failure), dopamine beta-hydroxylase deficiency, and non-diabetic autonomic neuropathy. The exact mechanism of action of droxidopa in the treatment of neurogenic orthostatic hypotension is unknown. Droxidopa is a synthetic amino acid analog that is directly metabolized to norepinephrine by dopa-decarboxylase, which is extensively distributed throughout the body Droxidopa is believed to exert its pharmacological effects through norepinephrine and not through the parent molecule or other metabolites. Norepinephrine increases blood pressure by inducing peripheral arterial and venous vasoconstriction.
The role of Droxidopa in treating neurogenic orthostatic hypotension is to increase blood pressure by inducing peripheral arterial and venous vasoconstriction through its metabolite norepinephrine.
- Key points:
- Indication: Droxidopa is indicated for the treatment of orthostatic dizziness, lightheadedness, or the “feeling that you are about to black out” in adult patients with symptomatic neurogenic orthostatic hypotension (nOH).
- Mechanism of action: The exact mechanism of action is unknown, but it is believed to exert its effects through norepinephrine.
- Effectiveness: Effectiveness beyond 2 weeks of treatment has not been established, and the continued effectiveness should be assessed periodically 2.
From the Research
Role of Droxidopa in Treating Neurogenic Orthostatic Hypotension
- Droxidopa is a safe and effective drug for the short-term management of neurogenic orthostatic hypotension (NOH) symptoms 3, 4, 5.
- The efficacy of droxidopa has been demonstrated in patients with NOH secondary to primary autonomic failure, dopamine beta-hydroxylase deficiency, and nondiabetic autonomic neuropathy 4.
- Droxidopa has been shown to improve standing systolic blood pressure and reduce symptoms of dizziness and lightheadedness in patients with NOH 3, 4, 6, 5.
- The drug has been approved for the treatment of symptomatic NOH in adults, including those with Parkinson's disease, multiple system atrophy, and pure autonomic failure 4, 6.
Efficacy and Safety of Droxidopa
- Studies have demonstrated the efficacy of droxidopa in improving NOH symptoms and activities of daily living in patients with NOH 7, 6.
- Droxidopa has been shown to be well-tolerated, with minimal drug interactions and adverse effects 4, 6.
- The most common adverse events reported with droxidopa include headache, dizziness, nausea, and hypertension 6, 5.
Long-term Efficacy of Droxidopa
- While droxidopa has been shown to be effective in the short-term management of NOH symptoms, its long-term efficacy is less clear 3, 7.
- A 12-week open-label study demonstrated significant improvements in NOH symptoms and activities of daily living with droxidopa treatment 7.
- Further studies are needed to confirm the long-term efficacy of droxidopa for the treatment of NOH 3, 7.