Could Northera (Droxidopa) Be an Alternative Treatment for Low Blood Pressure and Passing Out Symptoms in Parkinson’s Disease?
- Many PD patients visit the emergency room or clinic because of dizziness and/or syncope (passing out)
- In most cases the heart issues are checked, but nothing is found
- Orthostatic hypotension is common in PD, and affects 15-50% of patients
- A drop in systolic blood pressure of greater than 20 mmHg, or a drop in diastolic blood pressure of greater than 10mmHg within 3 minutes of changing to a standing position
- Consider reducing or eliminating the medications that contribute to the problem, including antihypertensives
- Dopaminergic medication (particularly a dopamine agonist) may worsen orthostatic hypotension
- You may try increasing fluid intake, increasing dietary salt and caffeine, and using tight, thigh-high support stockings to prevent pooling of blood below the waist. Purchasing a hospital bed, or raising the head of a normal bed 10-30 degrees may improve standing blood pressure when performed on a regular basis over several weeks. If needed, pharmacologic agents to raise blood pressure may be used. The most common drugs are Midodrine or Florinef.
- The newest medication recently obtained FDA approval is called droxidopa (Northera), L-threo-3,4,-dihydroxyphenylserine.
- This drug is a pro-drug of norepinephrine
- The drug may be useful in Parkinson's disease, multiple system atrophy (MSA) and in cases of pure autonomic failure
- The one side effect of Nothera that is potentially most worrisome is a large rise in blood pressure when laying down (supine hypertension)
- Read the full article on Northera at Dr. Okun's What's Hot column at NPF or the posting by Dr. Okun at the New England Journal of Medicine Journal Watch Neurology.
Ha AD, Brown CH, York MK, Jankovic J. The prevalence of symptomatic orthostatic hypotension in patients with Parkinson's disease and atypical parkinsonism. Parkinsonism Relat Disord. 2011 Jun 18.
Mostile G, Jankovic J. Treatment of dysautonomia associated with Parkinson's disease. Parkinsonism Relat Disord. 2009 Dec;15 Suppl 3:S224-32.
Okun MS, Fernandez HH. Ask the Doctor about Parkinson’s Disease. Demos Medical Publishing, 2010.