L-dihydroxyphenylserine (Droxidopa) in the treatment of orthostatic hypotension

  title={L-dihydroxyphenylserine (Droxidopa) in the treatment of orthostatic hypotension},
  author={Christopher J. Mathias},
  journal={Clinical Autonomic Research},
  • C. Mathias
  • Published 27 March 2008
  • Biology
  • Clinical Autonomic Research
Neurogenic orthostatic hypotension is a cardinal feature of generalised autonomic failure and commonly is the presenting sign in patients with primary autonomic failure. Orthostatic hypotension can result in considerable morbidity and even mortality and is a major management problem in disorders such as pure autonomic failure, multiple system atrophy and also in Parkinson’s disease. Treatment is ideally two pronged, using non-pharmacological and pharmacological measures.Drug treatment ideally… 

Droxidopa for the treatment of neurogenic orthostatic hypotension in neurodegenerative diseases

The authors review the effects of droxidopa in NOH with a focus on the neurodegenerative diseases PD, MSA, and pure autonomic failure (PAF, where results appear essentially similar) and indicates a positive yet short-lasting effect of the drug on OH Questionnaire composite score, light-headedness/dizziness score, and standing BP during the first two treatment-weeks.

L-DOPS and the treatment of neurogenic orthostatic hypotension

This review includes Phase II and III clinical trials undertaken that have examined the safety, efficacy and tolerability of DOPS in the treatment of neurogenic orthostatic hypotension.

Droxidopa for the treatment of neurogenic orthostatic hypotension and other symptoms of neurodegenerative disorders

Results from a few small and short placebo-controlled trials and clinical studies in neurogenic OH showed significant reductions in the manometric drop of blood pressure after posture changes or meals, but larger Phase III studies suggest a positive effect of the drug on dizziness.

Droxidopa | MedChemExpress

  • Biology
  • 2019
The acute administration of droxidopa in PVL and BDL rats caused a significant and maintained increase in arterial pressure and mesenteric arterial resistance, with a significant decrease of mesenterIC arterial and portal blood flow, without changing portal pressure and renal blood flow.

Droxidopa (L-DOPS)

Orthostatic hypotension in Parkinson's disease

The most important unanswered questions about PD-related OH, which may be the result of pre- and post-ganglionic adrenergic denervation or cognitive dysfunction, are discussed.

New Developments in the Management of Neurogenic Orthostatic Hypotension

Droxidopa was approved by the FDA in 2014 for the treatment of neurogenic OH associated with primary autonomic neuropathies including Parkinson disease, multiple system atrophy, and pure autonomic failure, in an attempt to provide a practical guide to its management.

Rascol , Olivier Emerging drugs for autonomic dysfunction in Parkinson ' s disease

Evidence about the efficacy and safety of available treatments for autonomic dysfunction and potential targets for upcoming therapies are discussed, and preliminary evidence suggesting that fludrocortisone, domperidone, droxidopa or fipamezole may be effective for the treatment of orthostatic hypotension is suggested.

Emerging drugs for autonomic dysfunction in Parkinson's disease

Sound clinical trials are needed in order to allow firm evidence-based recommendations about these treatments, including BTX or behavioral therapy for urinary incontinence and lubiprostone and probiotics for constipation.

Diagnosis and Treatment of Orthostatic Hypotension in Parkinson's Disease

The key physiopathological aspect of OH is an altered baroreflex function resulting from cardiac and vascular sympathetic denervation, which can be aggravated by heat, alcohol consumption or by drug treatments, such as antihypertensives, dopamine agonists or amantadine.



Norepinephrine Precursor Therapy in Neurogenic Orthostatic Hypotension

Acute administration of L-DOPS increases blood pressure and improves orthostatic tolerance in patients with NOH and the pressor effect results from conversion of L–aromatic amino acid decarboxylase to NE outside the central nervous system.

l-threo-dihydroxyphenylserine (l-threo-DOPS; droxidopa) in the management of neurogenic orthostatic hypotension: A multi-national, multi-center, dose-ranging study in multiple system atrophy and pure autonomic failure

The dosage of 300 mg twice daily seemed to offer the most effective control of symptomatic orthostatic hypotension in MSA and PAF, with the 2 serious adverse events reported being a possible complication of the disease under study, and with no reports of supine hypertension.

Autonomic diseases: management

  • C. Mathias
  • Medicine
    Journal of neurology, neurosurgery, and psychiatry
  • 2003
The management of autonomic disease encompasses a number of aspects. Of immediate and practical importance is alleviation of symptoms. The ideal is to rectify the autonomic deficit and cure the

[Effects of L-threo-Dops on orthostatic hypotension in Parkinson's disease].

The group that showed improvement in orthostatic syncope had a significant improvement in decline in blood pressure by standing after administration of L-threo-Dops, while the group without any change in severity of syncope did not showsignificant improvement in Orthostatic hypotention.

EFNS guidelines on the diagnosis and management of orthostatic hypotension

Evidence based guidelines for the diagnostic workup and the therapeutic management (non‐pharmacological and pharmacological) are provided based on the EFNS guidance regulations.

Autonomic diseases: clinical features and laboratory evaluation

  • C. Mathias
  • Medicine
    Journal of neurology, neurosurgery, and psychiatry
  • 2003
The history of the autonomic nervous system is of particular importance in the consideration and recognition of autonomic disease, and in separating dysfunction that may result from non-autonomic disorders.

Clinical, autonomic and therapeutic observations in two siblings with postural hypotension and sympathetic failure due to an inability to synthesize noradrenaline from dopamine because of a deficiency of dopamine beta hydroxylase.

Treatment of both patients with the synthetic amino acid, d-l-threo-dihydroxyphenylserine, which contains a hydroxyl group and is converted to noradrenaline by dopa-decarboxylase, reduced symptoms and signs of postural hypotension and increased levels of plasma nor adrenaline and its urinary metabolites.

Pharmacokinetic studies of oral L-threo-3,4-dihydroxyphenylserine in normal subjects and patients with familial amyloid polyneuropathy

It was concluded that the effects on plasma norepinephrine and blood pressure of oralL-threo-DOPS were essentially equal to those of twice as large a dose ofDl- threo -3,4-dihydroxyphenylserine.

Cognitive functioning in orthostatic hypotension due to pure autonomic failure

It is speculated that the cognitive impairments associated with PAF represent consequences of systemic hypotension with cerebral underperfusion, however, a failure in integrated bodily arousal responses during cognitive behaviours may also contribute to some of the observed deficits.