Oral Vasoactive Medications: A Summary of Midodrine and Droxidopa as Applied to Orthostatic Dysfunction

Abstract

This is a summary of the uses and applications of two vasoactive drugs, Midodrine (ProAmatine) and Droxidopa (Northera), in the treatment of Orthostatic Dysfunction (OD) disorders, including Neurogenic Orthostatic Hypotension, Postural Orthostatic Tachycardia Syndrome (POTS). This summary based on 15 years of experience monitoring and serially treating over 4000 patients with OD from all around the world and supportive literature. OD caused by an abnormal (decrease) in α-adrenergic, or α-Sympathetic, activity when assuming a head-up posture (e.g., sitting or standing). OD symptoms typically include lightheadedness, brain-fog, neurocognitive loss, fatigue, sleep difficulties, anxiety, and Syncope. Decreasing α-adrenergic activity upon head-up postural change often underlies OD and may be relieved with vasoactive medications. Midodrine and Droxidopa are the only medications that are FDA approved and approved for NOH. Except for their specific uses with NOH, these medications are used off-label with other forms of OD, including POTS, Orthostatic Hypotension, Orthostatic Intolerance and Vasovagal Syncope when co-morbid with OD. This summary will expand the knowledge of Midodrine and Northera, describe their advantages and disadvantages, and describe their comparative data. Hope this summary will help to make the clinician more comfortable diagnosing these disorders as well as using these treatments for this large population of patients with poor Quality of Life and poor functioning