Droxidopa Disease Interactions

Droxidopa is directly metabolized in vivo to norepinephrine via decarboxylation. As such, it may exacerbate certain cardiovascular conditions by increasing blood pressure and heart rate. Therapy with droxidopa should be considered cautiously in patients with ischemic heart disease, arrhythmias, or congestive heart failure. Additionally, droxidopa may exacerbate supine hypertension in patients with neurogenic orthostatic hypotension. Patients should be advised to elevate the head of the bed while resting or sleeping. Blood pressure should be monitored both in supine position and the head- elevated sleeping position. If hypertension persists, then droxidopa dosage should be reduced or discontinued. If hypertension is not well managed, it can increase the risk of cardiovascular events, especially stroke.

Droxidopa and its metabolites is primarily cleared by the kidneys. Patients with mild and moderate renal impairment did not show adverse reactions in clinical trials. However, the clinical experience in patients with severe renal function (GFR < 30 mL/min) is limited. Caution is advised in patients with severe renal impairment.