Initiation of droxidopa during hospital admission for management of refractory neurogenic orthostatic hypotension in severely ill patients. Issue 9 (1st August 2019)

• Record Type: Journal Article
• Authors: McDonell, Katherine E.; Preheim, Brock A.; Diedrich, Andre'; Muldowney, James A. S.; Peltier, Amanda C.; Robertson, David; Biaggioni, Italo; Shibao, Cyndya A.
• Is Part Of: Journal of clinical hypertension. Volume 21:Issue 9(2019)
• Page Start: 1308
• Page End: 1314
• Publication Date: 2019-08-01
• Subjects: droxidopa -- orthostatic hypotension -- safety; Hypertension -- Periodicals; 616.132
• DOI: 10.1111/jch.13619
• Languages: English
• ISSNs: 1524-6175

Abstract

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 four patients. One death occurred during hospital admission due to organ failure associated with end‐stage amyloidosis. Treating physicians noted improvements in presyncopal symptoms in 80% of patients. After 6 months, 13 patients (65%) continued on droxidopa therapy. In a retrospective cohort of hospitalized, severely ill patients with refractory nOH, supervised rapid titration of droxidopa was safe and effective. Treatment persistence was high, suggesting that symptomatic benefit extended beyond acute intervention.