droxidopa / Generic mfg. - LARVOL DELTA

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

Comparison of Inotrope Wean Success with use of Droxidopa compared to Midodrine in Patients with Heart Failure and Reduced Ejection Fraction (ASHP 2024) - No abstract available

Clinical • Cardiovascular • Congestive Heart Failure • Heart Failure

Utilization of Droxidopa at Novant Health (ASHP 2024) - No abstract available

Evaluation of the Effectiveness of Droxidopa Administration Via Enteral Tube for Vasopressor Weaning in a Medical Intensive Care Unit (ASHP 2024) - No abstract available

Critical care

THE TWO-HIT HYPOTHESIS?: NEW ONEST SEVERE CARDIOMYOPATHY AND CARDIAC ARRYTHMIA IN A HIGH RISK PATIENT WITH NEUROGENIC ORTHOSTATIC HYPOTENSION ON DROXIDOPA (AHA 2024) - "We encountered a patient with nOH on DD, who developed symptomatic frequent premature ventricular contractions (PVCs) and severe cardiomyopathy (CM).CaseA 52-year-old woman with a long-standing nOH had persistent lightheadedness, dizziness, presyncope and hypotension despite midodrine, fludrocortisone, and non-pharmacological measures. The rapid development of non-ischemic, non-infiltrative CM and cardiac arrythmia, which subsequently improved by stopping the DD, is alarming for DD's potential side effect.ConclusionCaution should be taken in prescribing DD in patients with nOH, who are at higher risk for development of cardiac arrythmia and cardiomyopathy. Further studies and data are needed in identifying or excluding the potential cardiovascular side effects."

Clinical • Atrial Fibrillation • Bone Marrow Transplantation • Cardiomyopathy • Cardiovascular • Hematological Malignancies • Hodgkin Lymphoma • Hypotension • Lymphoma • Oncology

Prescription trends in Japanese advanced Parkinson's disease patients with non-motor symptoms: J-FIRST. (PubMed, PLoS One) - "There were significant changes in the prescriptions and dosing of selected anti-PD drugs, especially newer drugs. Anti-PD drug and NSAID prescriptions also varied by changes in NMS status and geographic region."

Journal • Metastases • Observational data • CNS Disorders • Movement Disorders • Parkinson's Disease

Droxidopa for Management of Chronic Hypotension in Hemodialysis. (PubMed, Kidney Int Rep) - No abstract available

Journal • Hypotension

Multiple System Atrophy Masquerading as Drug-Resistant Orthostatic Hypotension. (PubMed, Cureus) - "Although he was treated with droxidopa and amezinium metilsulfate, his syncope was drug-resistant...Based on these findings, a clinical diagnosis of probable multiple system atrophy of the cerebellar type (MSA-C) was made, and treatment with taltirelin hydrate was initiated. This case underscores the importance of considering multiple system atrophy (MSA) in patients with persistent orthostatic hypotension and syncope, even before more obvious neurodegenerative symptoms emerge."

Journal • Ataxia • CNS Disorders • Hypotension • Movement Disorders • Multiple System Atrophy • Parkinson's Disease

Multitargeted docking approach reveals droxidopa against DNA replication and repair-related protein of cervical cancer. (PubMed, Sci Rep) - "Moreover, we performed the 100ns MD simulation in water, showing the controlled deviation and fluctuations of the residues with many interactions, and MMGBSA was performed with the same trajectories, showing a better understanding of each frame's total complex and binding-free energy. The whole study favours droxidopa as an inhibitor of cervical cancer DNA Replication and Repair-Related Proteins-however, experimental studies are needed before use."

Journal • Cervical Cancer • Gynecology • Infectious Disease • Musculoskeletal Pain • Oncology • Pain • Solid Tumor

Successful Use of Droxidopa to Treat Intractable Hypotension Attributed to Vasodilatory Shock Due to Autonomic Failure in a Patient with ESKD Who Is Dependent on Continuous Kidney Replacement Therapy (KIDNEY WEEK 2024) - "Many attempts and interventions (including midodrine 20 mg three times a day use) to wean off vasopressors and transition to intermittent hemodialysis were not successful over two months. Discussion. In a patient with intractable hypotension who therefore required being in the ICU to receive CRRT for many months, initiation and titration of Droxidopa successfully made the transition from CRRT to iHD with no further dependence on vasopressors.Droxidopa can be used to treat severe vasoppressors requiring neurogenic orthostatic hypotension caused by primary autonomic failure in Dialysis patients.."

Clinical • Hypotension • Nephrology • Primary Dysautonomia • Renal Disease

CLINICAL USE PATTERNS AND SAFETY PROFILE OF DROXIDOPA FOR INTRAVENOUS VASOPRESSOR WEANING IN SEPTIC SHOCK (CHEST 2024) - "Use of droxidopa monotherapy or in combination with midodrine may be safe for intravenous vasopressor weaning. The majority of discharged patients did not require outpatient continuation of oral vasopressors. Additional studies are required to evaluate droxidopa's effect on patient centered outcomes such as duration of intravenous vasopressor use, ICU length of stay, hospital length of stay, and mortality."

Clinical • Cardiovascular • CNS Disorders • Hypotension • Septic Shock

Effect of Orthostatic Hypotension Medications on Orthostatic Ratio: A Systemic Review and Meta-Analysis (MDS Congress 2024) - "Orthostatic ratio was not significantly affected by common treatments for orthostatic hypotension, which indicates that the ratio can be a reliable diagnosis indicator for neurogenic orthostatic hypotension regardless of medical therapy."

Retrospective data • Review • CNS Disorders • Parkinson's Disease

Case Report: Droxidopa-Induced False Positive Catecholamine Levels in Patient with Symptomatic Neurogenic Orthostatic Hypotension (ANA 2024) - "(2014). Neurology, 83(4)."

Case report • Clinical • CNS Disorders • Pain • Primary Dysautonomia

Droxidopa for Vasopressor Weaning in Critically Ill Patients with Persistent Hypotension: A Multicenter, Retrospective, Single-Arm Observational Study. (PubMed, J Intensive Care Med) - "Droxidopa may be considered an adjunct therapy for vasopressor weaning. Effects were similar when analyzing patients receiving droxidopa via feeding tube."

Journal • Observational data • Retrospective data • Cardiovascular • Critical care • Hypotension