Adult Dosing

Neurogenic Orthostatic Hypotension

• 100 mg PO tid
• Titrate to symptomatic response, in increments of 100 mg PO tid q24-48 hrs
• Max: 1800 mg/day

Note:

• Effectiveness beyond 2 weeks of treatment has not been demonstrated
• Administer upon arising 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
• Swallow capsule whole; do now chew, open, or dissolve contents
• Monitor supine blood pressure before initiating and after increasing the dose
• Patients who miss a dose should take their next scheduled dose; do not double the dose to make up for a missed dose

Pediatric Dosing

• Safety and efficacy in pediatric patients have not been established

• Treatment of symptomatic neurogenic orthostatic hypotension (NOH) in patients with primary autonomic failure, dopamine beta-hydroxylase deficiency, and nondiabetic autonomic neuropathy

• Hypersensitivity to any of the ingredients of the product

• Monitor blood pressure, both in the supine position and in the recommended head elevated sleeping position. If supine hypertension cannot be managed by elevation of the head of the bed, reduce dose or discontinue droxidopa

Renal Dose Adjustment (Based on CrCl)

• >30 mL/min: No dosage adjustment
• <30 mL/min: Caution advised

Hepatic Dose Adjustment

• Hepatic impairment: Dose adjustments not defined

• Therapy may worsen supine hypertension in patients with NOH. Advise patient to elevate the head of the bed when resting or sleeping
• Monitor blood pressure, both in the supine position and in the recommended head elevated sleeping position Reduce or discontinue therapy if supine hypertension persists. Therapy may increase risk of cardiovascular events If supine hypertension is not well managed
• Hyperpyrexia and confusion may occur with droxidopa
• Therapy may worsen symptoms in patients with existing ischemic heart disease, arrhythmias, and congestive heart failure. Consider potential risk prior to initiating therapy in patients with these conditions
• Therapy may cause allergic type reactions, including bronchial asthma, it is more frequently seen in patients who have aspirin hypersensitivity

Pregnancy Category:C

Breastfeeding: Safety unknown. Because of serious adverse reactions in nursing infants decision should be made to either discontinue nursing, or drug taking into account the importance of the drug to the mother.

• CNS: Headache, dizziness, syncope
• GU: Urinary tract infections
• GI: Nausea
• CV: Hypertension
• MISC: Hyperpyrexia, confusion

• Alpha/Beta adrenergic agonists; norepinephrine precursor; directly metabolized to norepinephrine by dopa-decarboxylase which is extensively distributed throughout the body, it elicits beta 1 and alpha-adrenergic effects and moderate beta2 effects, which increase cardiac output and heart rate, decrease renal perfusion and PVR, and cause variable BP effects
• Metabolized by aromatic L-amino acid decarboxylase
• Excreted in the urine, with the main metabolite being 3-O-methyldihydroxyphenylserine
• Half-life: 2-3 hours

US Trade Name(s)

• Northerea

US Availability

Northerea

• CAPS: 100, 200, 300 mg

Canadian Trade Name(s)

• N/A

Canadian Availability

• N/A

UK Trade Name(s)

• N/A

UK Availability

• N/A

Australian Trade Name(s)

• N/A

Australian Availability

• N/A

Cardiovascular

Alpha/Beta Adrenergic Agonists