Indications

Orthostatic Hypotension (see Hypotension)

• Neurologic Conditions Which Manifest Hypotension
  • Parkinson’s Disease (see Parkinson’s Disease)
  • Multiple System Atrophy (see xxxx)
  • Non-Diabetic Autonomic Neuropathy (see xxxx)

XXXX

• xxxx

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Pharmacology

Synthetic Amino Acid Which is Converted to Norepinephrine by the Enzyme Aromatic L-Amino Acid Decarboxylase (Dopa-Decarboxylase)

• Increases Blood Pressure by Acting at the Neurovascular Junction to Increase Vscular Tone

Metabolism

• Excretion
  • Urine (75%)
• Half-life Elimination: 2.5 hrs

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Administration

Oral (PO)

• Dose: 100 mg TID

Dose Adjustment

• Hepatic
  • No Dose Adjustments Provided in the Manufacturer Labeling
• Renal
  • GFR >30 mL/min: no dose adjustments necessary
  • GFR ≤30 mL/min: no dose adjustments provided in the manufacturer labeling

Drug Interactions

• Carbidopa (see xxxx)
  • Carbidopa May Decrease the Therapeutic Effect of Droxidopa (Risk C = Monitor Therapy)
  • Carbidopa May Decrease Serum Concentration of the Active Metabolite(s) of Droxidopa (Risk C = Monitor Therapy)
  • Carbidopa May Increase the Serum Concentration of Droxidopa (Risk C = Monitor Therapy)
• Midodrine (see Midodrine)
  • Midodrine May Increase the Hypertensive Effect of Droxidopa (Risk C = Monitor Therapy)
• Monoamine Oxidase (MAO) Inhibitors (see xxxx)
  • Monoamine Oxidase Inhibitors May Increase the Hypertensive Effect of Droxidopa (Risk X = Avoid Combination)
• Norepinephrine (Levophed) (see Norepinephrine)
  • Norepinephrine May Increase the Hypertensive Effect of Droxidopa (Risk C = Monitor Therapy)
• Serotonin 5-HT1D Receptor Agonists (Triptans) (see xxxx)
  • Serotonin 5-HT1D Receptor Agonists May Increase the Hypertensive Effect of Droxidopa (Risk C = Monitor Therapy)

Use in Pregnancy (see Pregnancy)

• Adverse Events Have Been Observed in Some Animal Reproduction Studies

Use During Breast Feeding

• Due to the Potential for Serious Adverse Reactions in the Nursing Infant, Breast Feeding is Not Recommended by the Manufacturer While Taking Droxidopa

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Adverse Effects

Allergic/Immunologic Adverse Effects

Anaphylaxis (see Anaphylaxis)

• Epidemiology
  • Cases Have Been Reported
• Clinical
  • Angioedema (ser Angioedema)
  • Bronchospasm/Wheezing (see Wheezing)
  • Rash
  • Urticaria (see Urticaria)

Cardiovascular Adverse Effects

Exacerbation of Existing Arrhythmias

• Epidemiology
  • XXXX
• Physiology
  • Due to Supine Hypertension

Exacerbation of Existing Congestive Heart Failure (CHF)

• Epidemiology
  • XXXX
  • Physiology
  • Due to Supine Hypertension

Exacerbation of Existing Coronary Artery Disease (CAD)

• Epidemiology
  • XXXX
• Physiology
  • Due to Supine Hypertension

Supine Hypertension (see Hypertension)

• Epidemiology
  • Occurs in 2-7% of Cases*

Gastrointestinal Adverse Effects

Nausea (see Nausea and Vomiting)

• Epidemiology
  • Occurs in 9% of Cases

Neurologic Adverse Effects

Confusion/Delirium (see Delirium)

• Epidemiology
  • XXXX

Dizziness (see Dizziness)

• Epidemiology
  • Occurs in 4-10% of Cases*

Headache (see Headache)

• Epidemiology
  • Occurs in 6-13% of Cases

Other Adverse Effects

Hyperpyrexia (see Fever)

• Epidemiology
  • XXXX

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References

• Droxidopa in neurogenic orthostatic hypotension. Expert Rev Cardiovasc Ther. 2015;13(8):875-91. doi: 10.1586/14779072.2015.1057504 [MEDLINE]