What is Droxidopa: Uses, Dosage, Side Effects and More

Droxidopa is a prescription medication that helps raise blood pressure in people who experience dangerous drops when standing up. This condition, called neurogenic orthostatic hypotension, can cause dizziness, fainting, and falls that significantly impact your daily life.

If you've been struggling with sudden dizziness when you stand or feeling like you might faint during simple activities, droxidopa might be the solution your doctor recommends. This medication works by converting into norepinephrine in your body, which helps tighten blood vessels and maintain steady blood pressure when you change positions.

What is Droxidopa?

Droxidopa is a synthetic amino acid that your body converts into norepinephrine, a natural chemical that helps control blood pressure. It's specifically designed for people whose nervous system can't properly regulate blood pressure when they stand up.

This medication belongs to a class called norepinephrine precursors, which means it provides the building blocks your body needs to make its own blood pressure-regulating chemicals. Think of it as giving your body the raw materials it needs to fix a broken blood pressure control system.

The FDA approved droxidopa in 2014 specifically for treating neurogenic orthostatic hypotension in adults. It's considered a specialized medication that requires careful monitoring by your healthcare provider.

What is Droxidopa Used For?

Droxidopa treats neurogenic orthostatic hypotension, a condition where your blood pressure drops dangerously when you stand up. This happens because your nervous system can't properly adjust your blood vessels and heart rate to maintain steady blood flow to your brain.

This condition commonly affects people with certain neurological disorders. Here are the main conditions where droxidopa helps:

• Parkinson's disease and related disorders
• Multiple system atrophy
• Pure autonomic failure
• Dopamine beta-hydroxylase deficiency
• Non-diabetic autonomic neuropathy

These conditions damage the part of your nervous system that automatically controls blood pressure, leaving you vulnerable to sudden drops that can cause fainting or falls.

Your doctor might also consider droxidopa if you have kidney failure on dialysis and experience severe blood pressure drops during treatment. However, this is less common and requires special consideration.

How Does Droxidopa Work?

Droxidopa works by becoming norepinephrine once it enters your body. Norepinephrine is a natural chemical that tells your blood vessels to tighten and your heart to pump more effectively, which helps maintain proper blood pressure.

When you have neurogenic orthostatic hypotension, your body doesn't make enough norepinephrine or can't use it properly. Droxidopa bypasses this problem by providing a direct pathway to create the norepinephrine you need.

The medication is considered moderately strong and typically takes effect within a few hours of taking it. Unlike some blood pressure medications that work immediately, droxidopa needs time to convert into the active form your body can use.

This conversion process happens gradually throughout your body, which helps provide more consistent blood pressure control compared to medications that work all at once.

How Should I Take Droxidopa?

Take droxidopa exactly as your doctor prescribes, usually three times daily with or without food. The typical starting dose is 100mg three times a day, but your doctor will adjust this based on how you respond.

You can take droxidopa with or without food, but try to be consistent with your choice. If you take it with food, stick to that routine, and if you take it on an empty stomach, continue doing so.

Here's how to take droxidopa safely:

1. Take your first dose in the morning, upon waking
2. Take the second dose at midday
3. Take the third dose in late afternoon, at least 3 hours before bedtime
4. Swallow the capsule whole with water
5. Don't crush, chew, or open the capsules

Avoid taking the last dose too close to bedtime because droxidopa can raise your blood pressure when lying down, which might be dangerous while you sleep.

If you're taking carbidopa for Parkinson's disease, continue taking it as prescribed. Carbidopa actually helps droxidopa work better by preventing it from converting to norepinephrine outside your brain.

How Long Should I Take Droxidopa For?

Most people need to take droxidopa long-term to manage their neurogenic orthostatic hypotension effectively. This condition is typically chronic, meaning it requires ongoing treatment rather than a short-term fix.

Your doctor will monitor your response during the first few weeks and may adjust your dose every few days until you reach the right amount. The maximum recommended dose is 600mg three times daily, but many people find relief with lower doses.

Plan to work closely with your healthcare provider during the first month of treatment. They'll want to check your blood pressure both lying down and standing up to ensure the medication is working properly without causing dangerous side effects.

Some people notice improvement within the first week, while others may need several weeks to experience the full benefits. Don't get discouraged if you don't feel better immediately.

What Are the Side Effects of Droxidopa?

Like all medications, droxidopa can cause side effects, though many people tolerate it well. The most common side effects are generally mild and often improve as your body adjusts to the medication.

Here are the most frequently reported side effects:

• Headache
• Dizziness
• Nausea
• High blood pressure when lying down
• Fatigue
• Urinary tract infections
• Falls (ironically, as your body adjusts to better blood pressure control)

These side effects usually occur during the first few weeks of treatment and often become less bothersome over time.

More serious side effects are less common but require immediate medical attention. Contact your doctor right away if you experience severe headaches, chest pain, shortness of breath, or confusion.

Some people develop what's called supine hypertension, where blood pressure becomes too high when lying down. Your doctor will monitor this carefully and may recommend sleeping with your head elevated or adjusting your evening dose.

Rarely, some people experience allergic reactions, irregular heartbeat, or kidney problems. These serious side effects are uncommon but require immediate medical care if they occur.

Who Should Not Take Droxidopa?

Droxidopa isn't safe for everyone, and certain medical conditions make it inappropriate or dangerous to use. Your doctor will carefully review your medical history before prescribing this medication.

You should not take droxidopa if you have any of these conditions:

• Severe high blood pressure that's difficult to control
• Closed-angle glaucoma
• Pheochromocytoma (a rare tumor that produces excess adrenaline)
• Severe heart disease or recent heart attack
• Severe kidney disease
• Known allergy to droxidopa or its ingredients

These conditions could become dangerous if droxidopa raises your blood pressure too much or interacts with your existing health problems.

Your doctor will also use extra caution if you have diabetes, mild kidney problems, or take certain medications for depression or Parkinson's disease. These situations don't necessarily prevent you from taking droxidopa, but they require closer monitoring.

Pregnant and breastfeeding women should discuss the risks and benefits with their doctor, as there isn't enough research to confirm droxidopa's safety during pregnancy or nursing.

Droxidopa Brand Names

Droxidopa is available under the brand name Northera in the United States. This is currently the only FDA-approved brand of droxidopa available to patients.

Northera is manufactured by Lundbeck and comes in capsule form with strengths of 100mg, 200mg, and 300mg. Your doctor will determine which strength is right for you based on your response to treatment.

Generic versions of droxidopa are not yet available in the United States, which means Northera can be expensive. However, the manufacturer offers patient assistance programs that may help reduce the cost if you qualify.

Always use the brand name Northera or ask your pharmacist specifically about droxidopa to ensure you receive the correct medication, as similar-sounding drug names could cause confusion.

Droxidopa Alternatives

If droxidopa doesn't work for you or causes troublesome side effects, several alternative treatments can help manage neurogenic orthostatic hypotension. Your doctor might recommend trying these options instead or in combination with droxidopa.

Here are the main alternatives to consider:

• Fludrocortisone (helps your body retain salt and water)
• Midodrine (directly tightens blood vessels)
• Compression stockings (physically prevents blood from pooling)
• Salt tablets and increased fluid intake
• Pyridostigmine (helps nerve signals work better)

Non-medication approaches often work well alongside or instead of droxidopa. These include sleeping with your head elevated, rising slowly from sitting or lying positions, and eating smaller, more frequent meals.

Some people find that increasing their salt intake and drinking more water helps maintain blood volume and prevents blood pressure drops. Your doctor can guide you on how much additional salt and fluid might be appropriate for your situation.

Each alternative has its own benefits and potential side effects, so work with your doctor to find the approach that works best for your specific situation and other health conditions.

Is Droxidopa Better Than Midodrine?

Both droxidopa and midodrine effectively treat neurogenic orthostatic hypotension, but they work differently and may be better suited for different people. The choice between them depends on your specific symptoms, other health conditions, and how you respond to each medication.

Droxidopa tends to provide more consistent blood pressure control throughout the day because it works by increasing your body's natural norepinephrine levels. This can lead to smoother, more predictable effects compared to midodrine's more immediate but shorter-lasting action.

Midodrine works faster than droxidopa, typically taking effect within an hour, while droxidopa may take several hours to show its full benefits. If you need quick relief from symptoms, midodrine might be more suitable initially.

However, droxidopa may cause fewer episodes of high blood pressure when lying down compared to midodrine. This makes it potentially safer for people who need to lie down frequently or have other conditions that make supine hypertension dangerous.

Your doctor will consider factors like your daily routine, other medications, kidney function, and how quickly you need symptom relief when choosing between these options. Some people even use both medications together under careful medical supervision.