droxidopa / Generic mfg. - LARVOL DELTA

Radiation-Induced Baroreflex Dysfunction: A Rare Case of Severe Orthostatic Hypotension. (PubMed, Cureus) - "Treatment with droxidopa, compression therapy, and a carefully titrated antihypertensive regimen led to improvement in orthostatic tolerance...The patient remained stable throughout the 10-month follow-up with sustained symptom improvement. This case underscores the importance of recognizing radiation as a potential cause of baroreflex failure in patients with significant polyvascular disease, expanding the spectrum of presentations to include earlier onset than historically reported."

Journal • Basal Cell Carcinoma • Cardiovascular • Hypertension • Hypotension • Non-melanoma Skin Cancer • Oncology

Refractory Hyponatremia in a Patient with Malignancy: A Role for Tolvaptan (KIDNEY WEEK 2025) - "She had decreased oral intake, fatigue, and a transient episode of unresponsiveness after taking her prescribed hydromorphone...She was given albumin and droxidopa for persistent low blood pressure and Nephrology was consulted for evaluation of persistent hyponatremia...The etiology of this patient’s hyponatremia is multifactorial including hypervolemia from hypoalbuminemia, non-osmotic ADH release from hypotension and sepsis, reduced solute intake and possible SIADH from malignancy. Tolvaptan was utilized because conventional management was challenged by contraindications."

Clinical • Cardiovascular • Fatigue • Gastroenterology • Genetic Disorders • Heart Failure • Hypotension • Infectious Disease • Nephrology • Oncology • Pancreatic Adenocarcinoma • Pancreatic Cancer • Pneumonia • Respiratory Diseases • Septic Shock

Effects of Midodrine and Droxidopa on Splanchnic Capacitance in Autonomic Failure (clinicaltrials.gov) - P1 | N=34 | Recruiting | Sponsor: Vanderbilt University Medical Center | Trial completion date: Dec 2025 ➔ Dec 2026 | Trial primary completion date: Sep 2025 ➔ Sep 2026

Trial completion date • Trial primary completion date • CNS Disorders • Hypotension • Movement Disorders • Multiple System Atrophy • Parkinson's Disease • Rare Diseases

A case of Parkinson's Disease whose Daily Levodopa/Carbidopa Intestinal Gel dose has been determined by her spouse and prevented Long-term Fluctuations (MDS Congress 2025) - "Other medications, that were droxidopa 900mg and rotigotine 13.5mg, were not changed. Patients with PD sometimes experience long-term fluctuations possibly due to temperature change, stressful situations, and bad health condition other than PD, even when medication is not changed. In this patient, careful LCIG dose change by the family member might prevent long-term fluctuations. Fig."

Clinical • CNS Disorders • Movement Disorders • Parkinson's Disease

Orthostatic Hypotension in Older Adults: A Narrative Review of Causes, Drug Impacts, and Management Strategies. (PubMed, Curr Hypertens Rev) - "Effective OH management requires a personalized, multidisciplinary approach. Fu-ture research should focus on identifying reliable diagnostic biomarkers and developing individu-alized treatment algorithms to improve patient outcomes and support healthy aging."

Journal • Cardiovascular • CNS Disorders • Hypotension • Movement Disorders • Parkinson's Disease

Repetitive syncope in a newborn leading to pacemaker implantation: Evidence for dopamine beta-hydroxylase deficiency. (PubMed, HeartRhythm Case Rep) - No abstract available

Journal • Genetic Disorders

Pharmacological Interventions for Orthostatic Hypotension: A Systematic Review. (PubMed, Cureus) - "Drugs approved by the U.S. Food and Drug Administration (FDA), such as droxidopa and midodrine, consistently improve orthostatic symptoms and are recommended as first-line therapies. Atomoxetine and fludrocortisone showed moderate efficacy, while pyridostigmine in combination therapies provided additional benefits...Adverse effects, including supine hypertension, dizziness, gastrointestinal disturbances, and fatigue, highlight the need for personalized therapy to balance efficacy and tolerability. While pharmacological treatments show promise, further comparative and long-term studies are necessary to refine therapeutic strategies and improve patient outcomes."

Journal • Review • Cardiovascular • CNS Disorders • Fatigue • Gastrointestinal Disorder • Hypertension • Hypotension

NORTHERA (DROXIDOPA) for Dysautonomia in Adult Survivors of Menkes Disease and Occipital Horn Syndrome (clinicaltrials.gov) - P1/2 | N=3 | Completed | Sponsor: Stephen G. Kaler, MD | Recruiting ➔ Completed

Trial completion

Intersection of Autonomic Dysfunction and Parkinson's Disease: Insights Into Neurogenic and Classical Orthostatic Hypotension. (PubMed, Cureus) - "Management requires a tailored approach, combining non-pharmacologic strategies, such as fluid and salt intake optimization, compression garments, and physical counter-maneuvers, with pharmacological treatments, including midodrine, droxidopa, and fludrocortisone. Emerging therapies and ongoing clinical trials offer promising avenues for future interventions. Early recognition and individualized management of OH are critical in PD care."

Journal • Review • Cardiovascular • CNS Disorders • Hypertension • Hypotension • Movement Disorders • Parkinson's Disease

Neurologic Medication Costs in a Direct-to-Consumer Pharmacy vs Commercial Insurance Plans. (PubMed, JAMA Netw Open) - "Among observed medications, teriflunomide (-40%) and droxidopa (-18%) had lower OOP and total costs in the direct-to-consumer pharmacy, with no other medications having lower OOP costs in the direct-to-consumer pharmacy...Practitioners should be aware of options such as direct-to-consumer pharmacies because they can often deliver similar OOP costs for uninsured patients to conventional pharmacies in commercial insurance plans. If pharmacies with direct-to-consumer pharmacy cost structures were widely used, total prescriptions may be markedly reduced."

HEOR • Journal • Reimbursement • US reimbursement

Northera Improves Postural Tachycardia Syndrome (POTS) and Postural Vasovagal Syncope (VVS) (clinicaltrials.gov) - P2 | N=30 | Terminated | Sponsor: New York Medical College | Active, not recruiting ➔ Terminated; Could not recruit adequate numbers. Largely closed by COVID risk.

Trial termination • Cardiovascular

Engineering of an L-threonine aldolase from Firmicutes bacterium for the stereoselective synthesis of Droxidopa. (PubMed, Int J Biol Macromol) - "Finally, the best mutant was subsequently applied to a scaled-up reaction, affording 1.3 g/L yield of L-threo-DOPS with 80 % de. This study provides new insights into the stereoselectivity control of LTAs and potential engineered LTAs for the manufacture of L-threo-DOPS."

Journal • CNS Disorders • Movement Disorders • Parkinson's Disease

DROP-AKI: Droxidopa to Increase Mean Arterial Pressure in Decompensated Cirrhosis Patients With Acute Kidney Injury (clinicaltrials.gov) - P2 | N=75 | Recruiting | Sponsor: Giuseppe Cullaro, MD | Not yet recruiting ➔ Recruiting

Enrollment open • Acute Kidney Injury • Fibrosis • Immunology • Liver Cirrhosis • Nephrology • Renal Disease

DROP-AKI: DROXIDOPA TO INCREASE MEAN ARTERIAL PRESSURE IN DECOMPENSATED CIRRHOSIS PATIENTS WITH ACUTE KIDNEY INJURY (clinicaltrials.gov) - P2 | N=75 | Not yet recruiting | Sponsor: Giuseppe Cullaro, MD

New P2 trial • Acute Kidney Injury • Fibrosis • Hepatology • Immunology • Liver Cirrhosis • Nephrology • Renal Disease

A RARE CASE OF SYNCOPE DUE TO CARDIOVASCULAR AUTONOMIC NEUROPATHY SUCCESSFULLY MANAGED WITH DROXIDOPA - Abraham Fatah (ACC 2025) - "Midodrine, fludrocortisone, and hydrocortisone were also given without improvement. Syncope is a multifactorial and complicated disease process. Patients with similar presentation and predisposing factors such as diabetes should be considered for this rare etiology. Early intervention and prevention of diabetes should be prioritized."

Clinical • Cardiovascular • Coronary Artery Disease • Diabetes • Diabetic Neuropathy • Hypotension • Metabolic Disorders • Pain • Type 2 Diabetes Mellitus

Droxidopa / Pyridostigmine in Orthostatic Hypotension (clinicaltrials.gov) - P2 | N=30 | Enrolling by invitation | Sponsor: Mayo Clinic | Suspended ➔ Enrolling by invitation | Trial completion date: May 2025 ➔ May 2026 | Trial primary completion date: May 2025 ➔ May 2026

Enrollment open • Trial completion date • Trial primary completion date • Cardiovascular • Hypertension • Hypotension

Alternative use of droxidopa for treating cervical cancer: inhibiting transferase, cell cycle signalling, and transport proteins via multitarget docking, DFT, MD simulations, and binding free energy studies. (PubMed, Med Oncol) - "The interaction fingerprints identified the most interacted residues with counts are 4GLN, 4GLU, 3ARG, and 3TRP, and the Pharmacokinetics and DFT analysis favoured the compound's suitability. Furthermore, 5 ns (nanoseconds) WaterMap for hydration sites and 100 ns MD simulation in NPT ensemble at 330 K temperature have resulted in acceptable deviations, fluctuations, and many intermolecular interactions, and binding free energy computations have favoured droxidopa's use against cervical cancer-however, experimental studies are needed before its use including the in-vitro and in-vivo studies."

Journal • Cervical Cancer • Infectious Disease • Oncology • Solid Tumor

Could Droxidopa Become the First Symptomatic Therapy for Charcot-Marie-Tooth Disease? A Case Series (AAN 2025) - "When insurance forced a switch to Fludrocortisone and Midodrine, he experienced a relapse in weakness consisting of inability to play golf and difficulty standing. Droxidopa may offer symptomatic relief for patients with CMT, especially motor symptoms. While further studies with larger patient populations and objective measures of improvement are needed to establish a definitive link, the observed improvements in functional motor daily activities, patient satisfaction and fine motor function suggest a potential therapeutic benefit."

Clinical • Genetic Disorders • Hypotension • Orthopedics • Pain

IMPACT OF DROXIDOPA ON HEMODYNAMIC SUPPORT AND VASOPRESSOR WEANING IN THE INTENSIVE CARE UNIT (SCCM 2025) - "Midodrine has been evaluated previously for this indication but has not demonstrated a benefit. Droxidopa did not appear to provide a benefit in improving hemodynamics or weaning vasopressors in patients in the ICU. However, these results may be limited by the small sample size. Larger scale studies are needed to further evaluate the potential role of droxidopa in the ICU."

Critical care

USE OF DROXIDOPA TO FACILITATE INTRAVENOUS VASOPRESSOR WEANING IN CRITICALLY ILL PATIENTS (SCCM 2025) - "Droxidopa may be a safe and effective option to facilitate weaning IV vasopressors in patients with hypotension refractory to midodrine. Given the retrospective nature of this study, larger prospective studies are warranted to confirm these findings."

Clinical • Cardiovascular • Hypertension • Hypotension

Electron transfer-chemical reaction-electron transfer study of dobutamine, isoprenaline, droxidopa, and methyldopa with carbon nanotube-based electrode. (PubMed, Anal Sci) - "This accelerated cyclization is attributed to (1) the presence of more complex substituents in these drugs and (2) the fact that dobutamine and isoprenaline are secondary amines, while dopamine and norepinephrine are primary amines. This study enhances the understanding of catecholamines and offers valuable insights for the development of novel electrochemical sensing strategies for catecholamine drugs."

Journal

Neurogenic Orthostatic Hypotension in Parkinson Disease-A Narrative Review of Diagnosis and Management. (PubMed, J Clin Med) - "Droxidopa and midodrine are the primary pharmacological agents for NOH, though emerging therapies, such as norepinephrine transporter inhibitors, are being investigated. Despite these advancements, further research is needed to better understand the underlying pathophysiology of NOH, enabling more tailored and effective treatment options for individuals with PD."

Journal • Review • Cardiovascular • CNS Disorders • Hypertension • Hypotension • Movement Disorders • Parkinson's Disease

Oral blood pressure augmenting agents for intravenous vasopressor weaning. (PubMed, World J Clin Cases) - "While midodrine appears to be the most frequently studied oral vasoactive agent for this purpose, its adverse effect profile may preclude its use in certain populations...The use of additional and alternative oral vasoactive agents bearing different mechanisms of action is emerging. This article provides a comprehensive review of the pharmacology, clinical uses, dosing strategies, and safety considerations of oral vasoactive agents and their application in the intensive care setting."

Journal • Review • Critical care • Hypotension

Effects of Midodrine and Droxidopa on Splanchnic Capacitance in Autonomic Failure (clinicaltrials.gov) - P1 | N=34 | Recruiting | Sponsor: Vanderbilt University Medical Center | Trial completion date: Dec 2024 ➔ Dec 2025 | Trial primary completion date: Sep 2024 ➔ Sep 2025

Trial completion date • Trial primary completion date • CNS Disorders • Hypotension • Movement Disorders • Multiple System Atrophy • Parkinson's Disease • Rare Diseases

Finding the Balance: Review of Pharmacological Management of Orthostatic Hypotension in Patients With Parkinson's Disease. (PubMed, J Gerontol Nurs) - "A patient-specific approach is needed to address OH in PD. Larger studies on safety and management of OH in PD are recommended given paucity of studies. [Journal of Gerontological Nursing, 50(12), 5-10.]."

Journal • Review • CNS Disorders • Hypotension • Movement Disorders • Parkinson's Disease