Objective: To determine the effect of droxidopa on clinical symptoms and standing systolic blood pressure in patients with Parkinson’s disease (PD) and neurogenic orthostatic hypotention (NOH).

Background: NOH due to autonomic dysfunction in PD not uncommonly complicates clinical management. Treatment options are limited, due both to limited symptomatic efficacy in some patients and to increases in supine hypertension (sHTN) in others. Studies using droxidopa to raise standing systolic blood pressure (sSBP) in patients with PD and nOH have identified short term improvement in symptoms and in sSBP, but clinical durability beyond 1-2 weeks has been limited by study design and other factors.

Methods: We retrospectively reviewed clinical symptoms, blood pressures, droxidopa dose, tolerability, and clinical durability of effect in 50 consecutive patients who were prescribed droxidopa at a routine clinic visit for symptomatic orthostatic hypotension. Concomitant medications and prior pressors were reviewed too. Some patients had 24 hour ambulatory blood pressure measured.

Results: Approxiamtely 50% of patients had previously been treated with pharmacologic agents to expand blood volume and/or to cause vasoconstriction but either had suboptimal improvement or adverse effects limiting treatment.. After treatment with droxidopa, most patients had a reduction in reported frequency and severity of orthostatic episodes. sSBP improved. Droxidopa had good tolerability without significant rise in supine blood pressure in most treated patients, with almost 80% remaining on treatment beyond 6 months. No pattern of response to concomitant medications was identified.

Conclusions: In this cohort of 50 consecutive patients treated with droxidopa for symptomatic NOH, clinical symptoms improved without limiting side effects in most patients. Clinical benefit appeared durable, with most patients cintinuing therapy long term.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/evaluation-of-droxidopa-dosing-and-clinical-response-in-50-consecutive-patients-with-parkinsons-disease-and-symptomatic-neurogenic-orthostatic-hypotension/