Freezing of gait in Parkinson's disease (off-label)
Side effects
With over 20 years on the market, droxidopa has proven to have few
side effects of which most are mild. The most common side effects reported in clinical trials include headache, dizziness, nausea, hypertension and fatigue.[6][7][8]
Droxidopa, also known as L-threo-dihydroxyphenylserine (L-DOPS), is chemically analogous to
levodopa (L-3,4-dihydroxyphenylalanine; L-DOPA). Whereas levodopa functions as a precursor and prodrug to
dopamine, droxidopa is a precursor and prodrug of
norepinephrine.[citation needed]
History
Droxidopa was developed by Sumitomo Pharmaceuticals for the
treatment of
hypotension, including NOH,[3] and NOH associated with various
disorders such as MSA, FAP, and PD, as well as IDH. The drug has been used in
Japan and some surrounding
Asian areas for these
indications since 1989. Following a merger with
Dainippon Pharmaceuticals in 2006,
Dainippon Sumitomo Pharma licensed droxidopa to Chelsea Therapeutics to
develop and
market it
worldwide except in Japan,
Korea,
China, and
Taiwan. In February 2014, the Food and Drug Administration approved droxidopa for the treatment of symptomatic neurogenic orthostatic hypotension.[10]
Clinical trials
A
systematic review and
meta-analysis conducted on
clinical trials comparing the clinical use of droxidopa and
midodrine have found that midodrine was more likely to cause
supine hypertension than droxidopa in patients with NOH. Midodrine was also found to be slightly more effective at raising blood pressure but not statistically significantly so.[11]
Chelsea Therapeutics obtained
orphan drug status (ODS) for droxidopa in the US for NOH, and that of which associated with PD, PAF, and MSA. In 2014, Chelsea Therapeutics was acquired by Lundbeck along with the rights to droxidopa which was launched in the US in Sept 2014.[12]
^
abMathias CJ (March 2008). "L-dihydroxyphenylserine (Droxidopa) in the treatment of orthostatic hypotension: the European experience". Clinical Autonomic Research. 18 (Supplement 1): 25–29.
doi:
10.1007/s10286-007-1005-z.
PMID18368304.
S2CID29861644.
^Calandra-Buonaura G, Doria A, Lopane G, Guaraldi P, Capellari S, Martinelli P, et al. (February 2016). "Pharmacodynamics of a low subacute levodopa dose helps distinguish between multiple system atrophy with predominant Parkinsonism and Parkinson's disease". Journal of Neurology. 263 (2): 250–256.
doi:
10.1007/s00415-015-7961-7.
PMID26566913.
S2CID189866517.
^Chen JJ, Han Y, Tang J, Portillo I, Hauser RA, Dashtipour K (December 2018). "Standing and Supine Blood Pressure Outcomes Associated With Droxidopa and Midodrine in Patients With Neurogenic Orthostatic Hypotension: A Bayesian Meta-analysis and Mixed Treatment Comparison of Randomized Trials". The Annals of Pharmacotherapy. 52 (12): 1182–1194.
doi:
10.1177/1060028018786954.
PMID29972032.
S2CID49674644.