Names and pronunciation
(drox′-i-doe′-pa) Northera
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Drug reference
(drox′-i-doe′-pa) Northera
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Func. class.: Cardiovascular agent, vasopressor
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ACTION: A synthetic amino acid pre- cursor of norepinephrine. It is used to increase blood pressure with symptomatic neurogenic orthostatic hypotension caused by primary autonomic failure (Parkinson’s disease, multiple system atrophy, and pure autonomic failure), dopamine beta-hydroxylase deficiency, or nondiabetic autonomic neuropathy
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USES: Symptomatic neurogenic ortho- static hypotension
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CONTRAINDICATIONS: Hyper sensitivity Precautions: Angina, breastfeeding, car- diac arrhythmias, cardiac disease, children, coronary artery disease, heart disease, hyperthermia, infants, mental status changes, myocardial infarction, neonates, pregnancy, salicylate/tartrazine dye hypersensitivity
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Black Box Warning: Supine hypertension Black Box Warning: Give tid at the follow- ing times: upon arising in the morning, at midday, and in the late afternoon at least 3 D hr prior to bedtime (to reduce the potential for supine hypertension during sleep) • Use without regard to food, but should be taken consistently in regard to food to ensure consistent absorption • Swallow capsules whole Black Box Warning: Supine hyperten- sion: monitor supine B/P prior to and at every dosage increase; assess response periodically. Advise to elevate the head of the bed when resting or sleeping to less- en the risk for supine hypertension. B/P should be monitored in supine position and in the recommended head-elevated sleeping position. Reduce or discontinue if supine hypertension persists • Neuroleptic malignant syndrome: hy- perthermia, severe extrapyramidal dysfunc- tion, alterations in consciousness, mental status changes, and autonomic instability (tachycardia, blood pressure fluctuations, dia- phoresis). In those with Parkinson’s disease, this condition may occur with abrupt reduc- tion of products with dopaminergic properties • Arrhythmia exacerbation: exacerba- tion of existing ischemic cardiac disease (coronary artery disease, angina, myocar- dial infarction, HF); consider the potential risk prior to initiating therapy; if chest pain occurs during use, assess cardiac status • Pregnancy/breastfeeding: no well- controlled studies in pregnancy, breast- feeding Black Box Warning: Instruct patients to rest and sleep in an upper-body-elevated position and to monitor B/P (to reduce the potential for supine hypertension); to take ≥3 hr prior to bedtime • To take consistently with or without food • Not to double doses HIGH ALERT
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SIDE EFFECTS CNS: Headache, dizziness, fatigue CV: Supine hypertension, arrhythmia exacerbation, chest pain MISC: Urinary tract infection, neurolep- tic malignant syndrome
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INTERACTIONS Increase: droxidopa effects—carbidopa, serotonin receptor agonists, sympatho- mimetics Increase: hypertensive crisis—MAOIs
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DOSAGE AND ROUTES • Adult: PO 100 mg tid: upon arising in the morning, at midday, and in the late afternoon at least 3 hr prior to bedtime; titrate to re- sponse, by 100 mg tid q24-48 hr up to a dose of 600 mg PO tid, max 1800 mg/day
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Available forms: Capsules 100, 200, 300 mg
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Administer:
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Assess:
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Evaluate: • Therapeutic response: increased B/P
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CLINICAL CONSIDERATIONS
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Patient and caregiver information:
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PHARMACOKINETICS Peak 3-4 hr
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• Adult: PO 100 mg tid: upon arising in the morning, at midday, and in the late afternoon at least 3 hr prior to bedtime; titrate to re- sponse, by 100 mg tid q24-48 hr up to a dose of 600 mg PO tid, max 1800 mg/day
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