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Droxidopa for orthostatic hypotension: a systematic review and meta-analysis

Lookup NU author(s): Vicki Strassheim, Emerita Professor Julia Newton, Dr Maw Tan, Dr James FrithORCiD



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


Objective:The systematic review and meta-analysis aims to determine the efficacy and safety of droxidopa in the treatment of orthostatic hypotension, following its recent approvals in the United States.Methods:MEDLINE, EMBASE, PubMed, Cochrane Controlled Trials Register, Web of Science, ProQuest, and the WHO Clinical Trials Registry were searched. Studies were included if they randomized adults with orthostatic hypotension to droxidopa or to control, and outcomes related to symptoms, daily activity, blood pressure, or adverse events. Data were extracted independently by two reviewers. Risk of bias was judged against the Cochrane risk of bias tool and quality of evidence measured using Grading of Recommendations Assessment, Development and Evaluation criteria. A fixed-effects model was used for pooled analysis.Results:Of 224 identified records, four studies met eligibility, with a pooled sample size of 494. Study duration was between 1 and 8 weeks. Droxidopa was effective at reducing dizziness [mean difference -0.97 (95% confidence interval -1.51, -0.42)], overall symptoms [-0.52 (-0.98, -0.06)] and difficulty with activity [-0.86 (-1.34, -0.38)]. Droxidopa was also effective at improving standing SBP [3.9 (0.1, 7.69)]. Rates of adverse events were similar between droxidopa and control groups, including supine hypertension [odds ratio 1.93 (0.87, 4.25)].Conclusion:Droxidopa is well tolerated and effective at reducing the symptoms associated with neurogenic orthostatic hypotension without increasing the risk of supine hypertension.Registration: PROSPERO ID CRD42015024612

Publication metadata

Author(s): Strassheim V, Newton JL, Tan MP, Frith J

Publication type: Review

Publication status: Published

Journal: Journal of Hypertension

Year: 2016

Volume: 34

Issue: 10

Pages: 1933-1941

Print publication date: 01/10/2016

Acceptance date: 01/01/1900

ISSN (print): 0263-6352

ISSN (electronic): 1473-5598



DOI: 10.1097/HJH.0000000000001043