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Droxidopa
Droxidopa is a norepinephrine precursor used to treat neurogenic orthostatic hypotension (NOH), a condition characterized by low blood pressure upon standing due to autonomic nervous system dysfunction. Droxidopa helps to increase norepinephrine levels, improving blood pressure and reducing symptoms like dizziness, lightheadedness, and fainting. It is commonly prescribed for individuals with conditions such as Parkinson’s disease, multiple system atrophy, and pure autonomic failure.
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Frequently Asked Questions
How long does it take for Droxidopa to start working?
Droxidopa generally starts working within a few hours of taking the first dose, with improvements in symptoms like dizziness and lightheadedness often seen within a few days.
Can I take Droxidopa with food?
Yes, Droxidopa can be taken with or without food. However, taking it with food may help reduce stomach upset.
What should I do if I miss a dose of Droxidopa?
If you miss a dose, take it as soon as you remember. If it is close to your next scheduled dose, skip the missed dose and take the next one at the usual time. Do not double up on doses.
Is Droxidopa safe to use long-term?
Yes, Droxidopa is typically used for long-term management of neurogenic orthostatic hypotension, but regular monitoring of blood pressure is important to ensure it remains effective and safe.
Can Droxidopa cause high blood pressure?
Yes, Droxidopa can cause supine hypertension, particularly when lying down. It’s important to monitor your blood pressure and avoid lying flat for long periods after taking the medication.
Comprehensive Drug Guide
How Does Droxidopa Work?
Droxidopa is converted to norepinephrine in the body, a neurotransmitter that helps constrict blood vessels and increase blood pressure. By elevating norepinephrine levels, Droxidopa reduces the symptoms of neurogenic orthostatic hypotension, improving the ability to stand and reducing the risk of fainting.
Common Dosages
- Capsules: 100 mg, 200 mg, 300 mg
Typical Dosing
- For neurogenic orthostatic hypotension (NOH): The typical starting dose is 100 mg taken three times daily. The dose can be increased by 100 mg every 24-48 hours, up to a maximum of 600 mg three times daily, based on the patient’s response.
Typical Dosing
FDA Approved Indications
Neurogenic orthostatic hypotension (NOH) in patients with Parkinson’s disease, multiple system atrophy, and pure autonomic failure.
Who Shouldn't Take Droxidopa?
- Known hypersensitivity to Droxidopa or any component of the formulation
- Severe hypertension
- Untreated heart conditions, such as severe coronary artery disease
Advice From The Pharmacist
- Take Droxidopa exactly as prescribed, usually three times a day, with the last dose taken at least 3 hours before bedtime to avoid elevated blood pressure while lying down.
- Monitor blood pressure regularly, both while sitting and standing, to ensure the medication is working effectively.
- Avoid activities that could exacerbate symptoms of low blood pressure, such as standing for prolonged periods without support.
- If you experience severe headaches, chest pain, or vision changes, contact your healthcare provider immediately.
Side Effects of Droxidopa
Common Side Effects
- Headache
- Dizziness
- Fatigue
- Nausea
Uncommon/Severe Side Effects
- Hypertension (high blood pressure), especially while lying down (supine hypertension)
- Chest pain or rapid heart rate
- Severe allergic reactions (rash, swelling, difficulty breathing)
Risks and Warnings of Droxidopa
- Supine Hypertension: Droxidopa can cause an increase in blood pressure when lying down, leading to supine hypertension. It is important to monitor blood pressure and avoid lying flat for extended periods.
- Cardiovascular Risks: Patients with heart disease or high blood pressure should be monitored closely, as Droxidopa may increase blood pressure and heart rate.
- Allergic Reactions: In rare cases, Droxidopa can cause severe allergic reactions. Discontinue use and seek medical attention if you experience symptoms like swelling, hives, or difficulty breathing.
Interactions with Droxidopa
Common Drug Interactions
- Blood pressure medications: Droxidopa may interact with medications that lower blood pressure, leading to excessive drops in blood pressure.
- MAO inhibitors: Combining Droxidopa with MAO inhibitors may increase the risk of hypertensive episodes.
- Dopamine antagonists: Medications that block dopamine receptors may interfere with the effectiveness of Droxidopa.
Alternatives to Droxidopa
- Midodrine: Another medication used to treat orthostatic hypotension, which works by constricting blood vessels to raise blood pressure.
- Fludrocortisone: A corticosteroid used to help manage orthostatic hypotension by increasing sodium retention, leading to higher blood pressure.
- Pyridostigmine: Sometimes used to treat orthostatic hypotension by improving nerve signaling that regulates blood pressure.
