Initiation of droxidopa during hospital admission for management of refractory neurogenic orthostatic hypotension in severely ill patients

The Journal of Clinical Hypertension
K. E. McDonellCyndya A Shibao

Abstract

Orthostatic hypotension (OH) is a common cause of hospitalization, particularly in the elderly. Hospitalized patients with OH are often severely ill, with complex medical comorbidities and high rates of disability. Droxidopa is a norepinephrine precursor approved for the treatment of neurogenic OH (nOH) associated with autonomic failure that is commonly used in the outpatient setting, but there are currently no data regarding the safety and efficacy of droxidopa initiation in medically complex patients. We performed a retrospective review of patients started on droxidopa for refractory nOH while hospitalized at Vanderbilt University Medical Center between October 2014 and May 2017. Primary outcome measures were safety, change in physician global impression of illness severity from admission to discharge, and persistence on medication after 180-day follow-up. A total of 20 patients were identified through chart review. Patients were medically complex with high rates of cardiovascular comorbidities and a diverse array of underlying autonomic diagnoses. Rapid titration of droxidopa was safe and well tolerated in this cohort, with no cardiovascular events or new onset arrhythmias. Supine hypertension requiring treatment occurred in...Continue Reading

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Citations

Aug 2, 2019·The Journal of Clinical Hypertension·Kyriakos DimitriadisDimitris Tousoulis
Aug 28, 2019·Clinical Autonomic Research : Official Journal of the Clinical Autonomic Research Society·Jose-Alberto PalmaHoracio Kaufmann
Oct 16, 2020·Seminars in Neurology·Cyndya A Shibao, Italo Biaggioni
May 8, 2021·Current Hypertension Reports·Vasiliki KatsiKonstantinos Tsioufis
Aug 21, 2021·The American Journal of Medicine·Amr WahbaItalo Biaggioni

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