Which medications in the drug class Alpha-adrenergic agonists are used in the treatment of Idiopathic Orthostatic Hypotension and other Autonomic Failure Syndromes?

Updated: Oct 21, 2018
  • Author: Mohini Gurme, MD; Chief Editor: Selim R Benbadis, MD  more...
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Alpha-adrenergic agonists

These agents improve the hemodynamic status by increasing blood pressure. Midodrine forms the active metabolite desglymidodrine, which is an alpha1-agonist. Desglymidodrine exerts its actions via activation of the alpha-adrenergic receptors of the arteriolar and venous vasculature, producing an increase in vascular tone and elevation of blood pressure. Droxidopa increases blood pressure by conversion to norepinephrine, but has no clinically significant effect on standing or supine heart rates in patients with autonomic failure.

Midodrine (ProAmatine)

Alpha-adrenergic agonist used in orthostatic hypotension to increase standing blood pressure. Acts at level of resistance vessels and is useful for peripherally mediated hypotension.

Droxidopa (Northera)

Droxidopa is a norepinephrine precursor that is metabolized to norepinephrine by dopa-decarboxylase. Norepinephrine increases blood pressure by inducing peripheral arterial and venous vasoconstriction. It is indicated for symptomatic neurogenic orthostatic hypotension (NOH) in patients with primary autonomic failure (Parkinson's disease, multiple system atrophy, and pure autonomic failure), dopamine beta-hydroxylase deficiency, and nondiabetic autonomic neuropathy.

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