Role of Droxidopa for Neurogenic Orthostatic Hypotension Still Unclear

Neurogenic orthostatic hypotension is a clinical syndrome characterized by a sustained drop in blood pressure upon becoming upright that leads to symptoms of brain hypoperfusion (e.g., lightheadedness, intolerance of the upright position, generalized weakness, and visual disturbances). It results from impaired compensatory autonomic reflexes due to either loss of central pathways that regulate sympathetic drive or degeneration of postganglionic sympathetic neurons. Investigators have now evaluated droxidopa, an orally administered artificial amino acid that is converted into norepinephrine, as treatment for neurogenic orthostatic hypotension, an indication for which the drug recently received FDA approval (NEJM JW Neurol Mar 18 2014). In th…