Droxidopa

Droxidopa is a prescription medication used in the treatment of orthostatic dizziness, lightheadedness, or the “feeling that you are about to black out” in adult patients with certain diseases of the autonomic system including Parkinson's disease. 

This medication is a synthetic amino acid analog that the body converts to norepinephrine. The exact way it works is unknown, but it is believed to work through the actions of norepinephrine which is known to raise blood pressure by constricting blood vessels.

Droxidopa comes in capsule form and is taken three times daily. Swallow droxidopa capsules whole. Take droxidopa the same way each time, either with or without food.

Common side effects include headache, dizziness, nausea, high blood pressure and fatigue.

• 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
• non-diabetic autonomic neuropathy

​This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Droxidopa may be found in some form under the following brand names:

• Northera

Serious side effects have been reported. See "Precautions" section.

Common side effects include:

• headache
• dizziness
• nausea
• high blood pressure
• fatigue

This is not a complete list of side effects. Ask your doctor or pharmacist for more information.

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take other medications that increase blood pressure such as norepinephrine, ephedrine, midodrine, and triptans. These medications would be expected to increase the risk for supine hypertension.

Serious side effects have been reported including:

Elevations in blood pressure. Droxidopa causes elevations in blood pressure and increases the risk of supine hypertension which could lead to strokes, heart attacks and death. It is important that when resting or sleeping you do so with your upper body in an elevated position. Monitor your blood pressure regularly and watch for increased blood pressure. Additionally, the late afternoon dose should be taken at least three hours before bedtime.

Excessively High Fever and Confusion. 

Ischemic Heart Disease, Arrhythmias, and Congestive Heart Failure. Droxidopa may worsen existing ischemic heart disease, arrhythmias, and congestive heart failure. 

Allergic Reactions. This product contains FD+C Yellow No. 5 (tartrazine) which may cause allergic-type reactions (including bronchial asthma) in certain susceptible persons. Although the overall incidence of FD+C Yellow No. 5 (tartrazine) sensitivity in the general population is low, it is frequently seen in patients who also have aspirin hypersensitivity. 

Medications can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of droxidopa, there are no specific foods that you must exclude from your diet when receiving this medication.

However, you should always take droxidopa the same way, either with or without food.

Before taking droxidopa, tell your doctor about all of your medical conditions. Especially tell your doctor if you:

• are allergic to any medications or FD+C Yellow No. 5 (tartrazine)
• have kidney disease
• have heart disease
• are pregnant or breastfeeding

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins and herbal supplements.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Droxidopa falls into category C. In animal studies, pregnant animals were given this medication and had some babies born with problems. No well-controlled studies have been done in humans. Therefore, this medication may be used if the potential benefits to the mother outweigh the potential risks to the unborn child.

Tell your doctor if you are breastfeeding or plan to breastfeed.

It is not known if droxidopa crosses into human milk. Because many medications can cross into human milk and because of the possibility for serious adverse reactions in nursing infants with use of this medication, a choice should be made whether to stop nursing or stop the use of this medication. Your doctor and you will decide if the benefits outweigh the risk of using droxidopa.

In rats, droxidopa is excreted in breast milk, and when the drug was administered to the nursing dams during the period of lactation, reduced weight gain and reduced survival were observed in the offspring. 

• Droxidopa comes in capsule form. 
• It is usually taken three times daily; first thing in the morning, at midday, and in the late afternoon at least 3 hours prior to bedtime (to reduce the potential for supine hypertension during sleep).
• Your doctor may start you at a low dose and gradually increase your dose as necessary to achieve maximum benefit.
• Swallow droxidopa capsules whole.
• You may take it with or without food. More importantly, it is best taken the same way each time, either with or without food.
• If a dose is missed, take the next dose at the regularly scheduled time and should not double the dose.

If you take too much droxidopa, call your local Poison Control Center or seek emergency medical attention right away.

If droxidopa is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if overdose is suspected, seek emergency medical attention.

• Store at room temperature between 20°C and 25°C (68°F-77°F).
• Keep this and all medications out of the reach of children.

Warning: Healthcare professionals and patients should be warned of the risk of increased blood pressure while lying down (supine hypertension), a common problem that affects people with primary autonomic failure and can cause stroke. It is essential that patients be reminded that they must sleep with their head and upper body elevated. Supine blood pressure should be monitored prior to and during treatment and more frequently when increasing doses.