Droxidopa in the Treatment of Postural Orthostatic Tachycardia Syndrome
Abstract
Background: Postural orthostatic tachycardia syndrome (POTS) is a constellation of signs and symptoms that occur when a patient is upright and relieved by recumbence. Currently, no drugs are labeled for the treatment for POTS. Droxidopa is an orally administered amino acid that is converted to norepinephrine and thought to improve both blood pressure and symptoms in patients with orthostatic intolerance. Study Question: To appraise the effect of Droxidopa in a clinical setting in patients with POTS refractory to other forms of treatment. Study Design: A retrospective study of patients with POTS at our Syncope and Autonomic Disorders Center. Three hundred fifty-two patients were screened, 54 of them were prescribed Droxidopa and found to be eligible to include in our study. Measures and Outcome: Symptoms of orthostatic intolerance, side effects of therapy and response to treatment. Statistical analyses were done using SPSS software. Thirty-seven patients were included in data analysis. Patients who failed to follow up, didn't obtain Droxidopa due to insurance and cost concerns, had hypertensive response to therapy or had allergic reaction were excluded from data analysis. Results: The most frequently reported symptom was dizziness in 91.9% of patients, followed by syncope and fatigue in 70.3% and 67.6% of patients, respectively. Symptoms of dizziness, syncope and fatigue were reported less after treatment; 75.7%, 51.4% and 40.5%, respectively. There was no statistically significant difference in standing or sitting blood pressure before and after treatment. Despite the improvement in some symptoms. Only 27% of patients reported improved quality of life after treatment. Of total, 40.5% of patients stopped the treatment either due to side effects or ineffectiveness. Conclusion: Droxidopa appears to improve some symptoms of orthostatic intolerance in patients with POTS but has diminutive impact on quality of life and blood pressure. Further assessment in large clinical trials is needed to evaluate its efficacy.
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Droxidopa has been studied in a small number of POTS patients; although it may have helped to improve some symptoms of orthostatic intolerance, it did not significantly improve quality of life.
“Droxidopa has been studied in a small number of POTS patients; although it may have helped to improve some symptoms of orthostatic intolerance, it did not significantly improve quality of life (111).”
From Postural Orthostatic Tachycardia Syndrome (2019) · cites this paper as [111]
Droxidopa has not been well studied prospectively, and a retrospective analysis demonstrated only modest improvement in symptoms.
“It has not been well studied prospectively, and a retrospective analysis demonstrated only modest improvement in symptoms (58).”
From Postural orthostatic tachycardia syndrome: mechanisms and new therapies (2020) · cites this paper as [58]
Droxidopa is a peroral norepinephrine precursor.
“Peroral norepinephrine precursor.”
From Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management (2019) · cites this paper as [95]
Droxidopa has been used off-label empirically in severe POTS.
“Drug has been empirically used offlabel in severe POTS.”
From Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management (2019) · cites this paper as [95]
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- Authors
- Ruzieh, M., Dasa, O., Pacenta, A., Karabin, B., & Grubb, B.
- Affiliations
- Internal Medicine and
- University of Toledo Medical Center (US)
- Corresponding author
- Ruzieh, Mohammed
- Venue
- American Journal of Therapeutics
- Published
- 2017-03
- Volume
- 24
- Issue
- 2
- Pages
- e157-e161
- ISSN
- 1075-2765 (ISSN-L)
- OpenAlex
- W2510615051
- Cited by
- 42
- References
- 13
- Citations by year
- 2025: 1 · 2024: 7 · 2023: 4 · 2022: 4 · 2021: 3 · 2020: 5 · 2019: 8 · 2018: 5 · 2017: 4
- FWCI
- 6.28
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Keywords
- droxidopa, postural orthostatic tachycardia syndrome, orthostatic intolerance, dizziness, syncope, fatigue, blood pressure, quality of life, treatment side effects
- MeSH terms
- Adult, Aged, Antiparkinson Agents, Dizziness, Fatigue, Female, Humans, Male, Middle Aged, Retrospective Studies, Syncope, Droxidopa, Treatment Outcome, Postural Orthostatic Tachycardia Syndrome
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