Northera (droxidopa) is an oral medicine used to treat sensations of dizziness, light-headedness, and a feeling of being on the verge of passing out or actually fainting — all symptoms that may result from a neurological disorder like Parkinson’s disease.

These symptoms, called neurogenic orthostatic hypotension (nOH), are due to a drop in blood pressure when standing up from a sitting or lying position. They result from a malfunction in the autonomic nervous system, which controls involuntary activity such as blood pressure.  nOH affects around 15% to 50% of Parkinson’s patients, usually those who are older, have had Parkinson’s for a longer time, and are in a more advanced disease stage.

How Northera works

Northera is in a class of medications called alpha and beta-adrenergic agonists, which work by increasing the levels of norepinephrine. Norepinephrine is a natural circulating chemical that helps to regulate blood pressure. Northera is directly metabolized to norepinephrine by a naturally occurring enzyme called dopa-dexarboxylase.

What to expect with Northera treatment?

Northera comes as a capsule to be swallowed whole, usually three times a day. Usually, people are started on a lower dose, which is gradually increased (the medication comes in 100 mg, 200 mg and 300 mg hard gelatin capsules, to be taken consistently with or without food).

Treatment of neurogenic orthostatic hypotension with Northera may cause high blood pressure when lying flat on the back, increasing the risk of cardiovascular complications such as a heart attack and stroke. It is strongly recommended that the head of the bed be raised, so the patient is not lying flat, and Northera final dose be taken at least three hours before bedtime.

It is important to check supine blood pressure before starting the treatment and regularly thereafter, especially when the dose is increased.

Northera’s effectiveness beyond two weeks of treatment has not been established, and the prescribing physician will need to decide whether or not this treatment is to be continued for more than two weeks.

The most common side effects of Northera are headaches, dizziness, nausea, and high blood pressure.

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