Droxidopa
NORTHERA
What it isNorepinephrine prodrug; neurogenic orthostatic hypotension.
Why this oneUnlike midodrine, it crosses the blood-brain barrier and replaces norepinephrine rather than directly constricting vessels.
What limits itSupine hypertension — the last dose must be at least three hours before lying down. Benefit may wane over months.
FDA-approved for
- orthostatic hypotension (2014)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Neurogenic orthostatic hypotension | Adults | 100 mg TID | Titrate to symptomatic response | 600 mg TID (1,800 mg/day) |
Titration Titrate in 100 mg TID increments every 24 to 48 hours
Renal GFR <30 mL/min: dosing recommendations cannot be provided
Hepatic Undefined
Instructions
- Take consistently with or without food
- Swallow capsule whole
- Give last dose at least 3 hours before bedtime and elevate head of bed
Cautions
- Supine hypertension and possible increased cardiovascular/stroke risk if unmanaged
- Hyperpyrexia and confusion (NMS-like symptom complex)
- May exacerbate ischemic heart disease, arrhythmias, and CHF
- Allergic reactions including anaphylaxis/angioedema
Adverse reactions
- Headache
- Dizziness
- Nausea
- Hypertension
Pregnancy No human data; animal studies showed reduced live fetuses/embryofetal deaths.
Lactation Breastfeeding not recommended.
⚠ BOXED WARNING
- Supine hypertension
Cost, est. cash$10–$300/month
Generic entry2021
Classes and tags
Clinical profile
Legacy pregnancy categoryUnknown / historical label unavailable
Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.
Active metabolites
Mechanism of action: Droxidopa ballicule
Open Droxidopa in the interactive console ↗
Memory aids: mascots and interaction avatars
drox = dog/fox hybrid
general color scheme of the norepinephrine ballicule → metabolized to NE