THERAPEUTICS

Brands

• Northera

Generic?

• No

Class

• Catecholamine analog

Commonly Prescribed for

(FDA approved in bold)

• Treatment of symptomatic neurogenic orthostatic hypotension (orthostatic dizziness, lightheadedness, syncope) in adult patients caused by primary autonomic failure (Parkinson's disease [PD], multiple system atrophy, pure autonomic failure, familial amyloid polyneuropathy), dopamine β-hydroxylase deficiency, and non-diabetic autonomic neuropathy

• Freezing of gait in PD

• Postural tachycardia syndrome (POTS)

• Prevention of orthostasis in hemodialysis patients

• Fibromyalgia

• Attention deficit hyperactivity disorder

• Chronic fatigue

How the Drug Works

• It is a synthetic catecholamino acid analog that is directly metabolized by dopa-decarboxylase to increase the concentrations of norepinephrine and epinephrine throughout the body. It also crosses the BBB and exerts its pharmacological effects within the CNS. Peripherally, it increases blood pressure by inducing peripheral arterial and venous vasoconstriction. It induces small and transient rises in plasma norepinephrine

• The contribution of other actions of droxidopa to its pharmacological effect is not well understood

How Long Until It Works

• Few days

If It Works

• May continue for a longer time, although no available study on treatment more than 2 weeks so far

If It Doesn't Work

• Correct any treatable underlying disorders

• Volume expansion: high-salt diet, increased fluid intake, fluorohydrocortisone

• Vasoconstriction: desmopressin (vasopressin analog), midodrine (α1 agonist)

Best Augmenting Combos for Partial Response or Treatment-Resistance

• Orthostasis: volume expansion and vasoconstriction

• POTS: volume expansion and vasoconstriction, exercise, cognitive behavioral therapy, propranolol, SNRIs, pyrostigmine

• Fibromyalgia: TCAs, SNRI, aerobic exercise, cognitive behavioral therapy

Tests

• None

ADVERSE EFFECTS (AEs)

How the Drug Causes AEs

• Elevated norepinephrine concentration

Notable AEs

• Headache, dizziness, nausea , supine hypertension, fatigue

Life-Threatening or Dangerous AEs

• Allergic reaction

• Neuroleptic malignant syndrome mimics (hyperpyrexia and confusion)

• May exacerbate existing ischemic heart disease, arrhythmias, and congestive heart failure

Weight Gain

• Unusual