• Treatment of orthostatic dizziness, lightheadedness or feeling of impending blackout associated with symptomatic neurogenic orthostatic hypotension due to primary autonomic failure (Parkinson's disease, multiple system atrophy), dopamine beta-hydroxylase deficiency or non-diabetic autonomic neuropathy.

Contraindicated in:

• Hypersensitivity to droxidopa or tartrazine (FD+C No. 5 [cross sensitivity between aspirin and FD+C No. 5 may occur])
• CCr <30 mL/min
• Lactation: Lactation.

Use Cautiously in:

• Hypertension (should be controlled prior to treatment)
• Mild to moderate renal impairment (↑ risk of adverse reactions)
• History of cardiovascular disease (may exacerbate hypertension, ischemic heart disease, arrhythmias or HF)
• OB: Safety not established in pregnancy
• Pedi: Safety and effectiveness not established in children
• Geri: Older adults may be more sensitive to drug effects.

CV: HF, ARRHYTHMIAS, MYOCARDIAL ISCHEMIA, supine hypertension.

GI: nausea.

Neuro: confusion, dizziness, fatigue, headache.
Misc: hyperpyrexia, (INCLUDING ANAPHYLAXIS AND ANGIOEDEMA)HYPERSENSITIVITY REACTIONS .

Drug-Drug:

• ↑risk of supine hypertension with other agents that ↑ BP including ephedrine, norepinephrine, midodrine, pseudoephedrine, and triptans.
• Concurrent use of DOPA decarboxylase inhibitors may require dose adjustments.

(Generic available)

• Capsules (contain tartrazine): 100 mg; 200 mg; 300 mg;

• PO (Adults): 100 mg three times daily, may be ↑ by 100 mg three times daily up to 600 mg three times daily (last dose should be given at least 3 hr prior to bedtime).

Northera

• Acts as a synthetic precursor that is converted by dopa decarboxylase to norepinephrine which produces peripheral arterial and venous vasoconstriction. Result is increased BP.

• Increased BP with decreased symptoms of orthostatic dizziness.

Therapeutic Classification: antihypotensives

Pharmacologic Classification: adrenergics

Absorption: Systemic absorption follows oral administration.

Distribution: Crosses the blood-brain barrier.

Metabolism/Excretion: Metabolized via catecholamine pathway; metabolites other than norepinephrine do not contribute to activity. 75% excreted by kidneys as parent drug and metabolites.

Half-life: 2.5 hr.

(↑ BP)

• Instruct patient to take droxidopa as directed. If dose is missed, omit and take next dose at scheduled time; do not double doses.
• Advise patient to raise head of bed when resting or sleeping.
• Instruct patient how to take BP and manage elevations.
• Advise patient to notify health care professional immediately if signs and symptoms of hypersensitivity reactions (anaphylaxis, facial swelling, difficulty breathing, itching, rash) or neuroleptic malignant syndrome occur.
• Advise female patient to notify health care professional if pregnancy is planned or suspected or and to avoid breastfeeding during therapy.

DROX-i-doe-pa