A medicine that raises blood pressure in neurogenic orthostatic hypotension
Droxidopa
A medicine used to raise blood pressure and reduce severe dizziness on standing in neurogenic orthostatic hypotension.
What is Droxidopa?
Droxidopa is a specialist medicine used to treat neurogenic orthostatic hypotension, where blood pressure drops sharply on standing and causes severe dizziness, light-headedness or fainting because the nervous system cannot control blood pressure properly. The body turns it into noradrenaline, a natural chemical that tightens blood vessels and raises blood pressure. The most important safety point is that it can push blood pressure too high when lying down (supine hypertension), so the last dose of the day is taken well before lying down and the head of the bed may be raised. It is started and supervised by a specialist.
Education and reference only. This is a plain-language guide to Droxidopa — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Droxidopa is a medicine used in neurogenic orthostatic hypotension, a problem in which the body cannot keep blood pressure up when a person stands, leading to severe dizziness, light-headedness, blurred vision or fainting. This happens in some conditions that affect the nervous system. Droxidopa is taken by mouth as capsules and is converted in the body into noradrenaline, a natural chemical that helps blood vessels tighten and supports blood pressure. It is a specialist treatment, started and adjusted under close supervision, and aimed at reducing the disabling dizziness that comes with standing.
How it works
Droxidopa is a building block that the body changes into noradrenaline, one of the natural chemicals that tightens blood vessels and keeps blood pressure up. In neurogenic orthostatic hypotension the nervous system does not release enough of this chemical when a person stands, so blood pressure falls and dizziness or fainting follows. By topping up noradrenaline, droxidopa helps blood pressure stay steadier on standing, reducing symptoms. Because it raises blood pressure, the same effect can make blood pressure too high when lying down, which is why timing of doses around lying down matters so much.
Company & origin
Originated / developed by: Specialist manufacturer.
A specialist medicine used to ease severe dizziness on standing caused by a faulty blood-pressure reflex in conditions affecting the nervous system.
Practical use
How to take Droxidopa
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take the capsules by mouth as your specialist directs, keeping to the timing you are given.
- Take the last dose of the day well before lying down, usually several hours before bedtime, to lower the risk of high blood pressure when lying flat.
- Avoid lying flat for a while after a dose, and raise the head of the bed if your specialist advises it.
- Keep to your appointments for blood-pressure checks both upright and lying down, as the dose is adjusted from these.
- Report a pounding headache, blurred vision or chest discomfort when lying down, as these can be signs of blood pressure that is too high.
Weighing it up
Advantages & disadvantages of Droxidopa
Advantages
- Can reduce the severe dizziness and light-headedness on standing that come with neurogenic orthostatic hypotension.
- Taken by mouth as capsules rather than by injection.
- Works with the body's own blood-pressure chemicals to support standing.
Disadvantages
- Can raise blood pressure too high when lying down, so dose timing has to be managed carefully.
- Needs regular blood-pressure checks both upright and lying down to find the right balance.
- Treats the dizziness on standing rather than curing the underlying condition.
Practical use
Good to know
The dominant safety issue with droxidopa is high blood pressure when lying down, called supine hypertension: the very effect that helps you stand can push blood pressure too high when you lie flat. For this reason the last dose of the day is taken several hours before going to bed, and the specialist may advise raising the head of the bed and avoiding lying flat after a dose. Blood pressure is usually checked both sitting or standing and lying down to find the right balance. It is started at a low level and adjusted carefully. Symptoms such as a pounding headache, blurred vision or chest discomfort when lying down can be signs of blood pressure that is too high and should be reported. It treats the dizziness on standing rather than curing the underlying condition.
Who should not take it / use with caution
- People who have had a serious allergic reaction to droxidopa should not take it.
- It is used with great caution, or avoided, in people whose blood pressure is already high when lying down, until that is controlled.
- It is used with care in people with certain heart problems, and should only be used under specialist supervision.
Monitoring
- Regular blood-pressure checks both upright and lying down to guide the dose and timing.
- Watching for signs of high blood pressure when lying down, such as a pounding headache.
- Reviewing how well symptoms on standing are controlled over time.
Side effects
- Headache, dizziness or feeling sick, especially early in treatment.
- High blood pressure when lying down, which dose timing and monitoring are designed to manage.
- Less commonly, a pounding headache, blurred vision or chest discomfort, which can signal blood pressure that is too high.
Key interactions
- Other medicines that raise blood pressure can add to its effect and increase the risk of blood pressure that is too high.
- Medicines used for low blood pressure or certain mood medicines may interact, so give your team a full list of what you take.
- Tell your prescriber about any blood-pressure medicines, as the balance between high and low pressure is delicate.
Available as: Capsules taken by mouth.
Answers
Droxidopa: frequently asked questions
What is droxidopa used for?
It is used to treat neurogenic orthostatic hypotension, where blood pressure drops on standing and causes severe dizziness, by helping the body raise blood pressure.
Why must I take the last dose well before lying down?
Droxidopa can push blood pressure too high when you lie flat, so the last dose is taken several hours before bedtime to lower that risk.
Why are my blood-pressure checks done both standing and lying down?
The dose has to balance enough blood pressure to stand against not too much when lying down, so it is measured in both positions.
What should I report straight away?
A pounding headache, blurred vision or chest discomfort when lying down can be signs of blood pressure that is too high, so report these to your team.
Does it cure the condition?
No. It eases the dizziness and fainting on standing but does not cure the underlying nervous-system condition causing it.
Authoritative sources
- BNF
- NICE CKS
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