While Parkinson’s Disease (PD) is one of the most common neurodegenerative conditions second only to Alzheimer’s, one might assume that the disease is well understood. Many people recognize the motor symptoms of Parkinson’s, like tremors at rest, loss of balance and difficulty moving, but there is a lesser-known and often less talked about non-motor aspect of the disease.
April is Parkinson’s Awareness Month. In an effort to educate and raise awareness of PD not only this month, but all year, there is a related but manageable condition called neurogenic orthostatic hypotension (nOH), that needs to be talked about. It is a condition where symptoms appear in approximately 20% of patients with PD.
Get to Know nOH
When a person without nOH stands up, gravity naturally pulls the blood to the lower part of the body, lowering blood pressure. When this happens, the nervous system typically releases a chemical called norepinephrine, which signals the blood vessels to tighten, or constrict. This raises blood pressure and makes it easier for the body to pump blood back up to the heart and brain.
For a person living with nOH, the body does not release enough norepinephrine upon standing. As a result, blood vessels are unable to tighten as they should, preventing the blood from being pumped back up to the head and upper torso.
What Symptoms Should One Look For?
Symptoms that nOH patients experience can be nonspecific. Some of these symptoms include:
- Feeling of blacking out
It’s important to take steps to capture these symptoms when you feel them. What were you doing? Were you standing or sitting? What time of day was it? A symptoms tracker may be helpful and serve as a tool to use when talking with your doctor.
How is nOH Treated?
There are a variety of lifestyle changes that may help ease the symptoms of nOH, like drinking two glasses of water, increasing your salt intake or wearing abdominal binders. In addition to lifestyle changes, there is also a treatment option available.
NORTHERA® (droxidopa) is a prescription medication that is indicated for the treatment of orthostatic dizziness, lightheadedness and the feeling of blacking out. Please review the full Use for NORTHERA and Important Safety Information below, including a boxed warning for Supine Hypertension. While NORTHERA might not be right for everyone, patients with a neurodegenerative condition can help their doctor determine if it could be the right fit for them by answering a quick online survey at NORTHERA.com and bringing their results to their physician.
This Parkinson’s Awareness Month, whether you’re living with PD or serve as a care partner for someone who is, be on the lookout for any symptoms that may be signs of nOH and speak to your doctor about the right treatment plan for you.
USE OF NORTHERA (droxidopa) CAPSULES (100 mg, 200 mg, 300 mg)
NORTHERA is a prescription medication used to reduce dizziness, lightheadedness, or the “feeling that you are about to black out” in adults who experience a significant drop in blood pressure when changing positions or standing (called symptomatic neurogenic orthostatic hypotension (nOH)) and who have one of the following:
- Parkinson’s disease (PD), a neurodegenerative disease that causes slowness in muscle movement as well as shaking in the hands
- Multiple system atrophy (MSA), a Parkinson’s-like disorder with more widespread effects on the brain and body
- Pure autonomic failure (PAF), a neurodegenerative disease that results in frequent drops in blood pressure upon standing
- Dopamine beta-hydroxylase deficiency, a condition where the body cannot make enough of the hormones that help regulate blood pressure
- Non-diabetic autonomic neuropathy, an inability to maintain blood pressure upon standing that can be caused by a number of rare diseases
Effectiveness beyond 2 weeks of treatment has not been established, and your doctor will decide if you should continue taking NORTHERA.
IMPORTANT SAFETY INFORMATION
- Do not take NORTHERA if you have a known allergy to NORTHERA or its ingredients.
- NORTHERA may cause high blood pressure when lying down, which could lead to strokes, heart attacks, and death. To reduce this risk of supine hypertension, take your late afternoon dose of NORTHERA at least 3 hours before going to bed.
- Neuroleptic malignant syndrome (NMS) is a rare but potentially life-threatening side effect reported with NORTHERA. Call your doctor right away and go to the nearest emergency room if you develop these signs and symptoms: high fever, stiff muscles, movements that you cannot control, confusion or problems thinking, very fast or uneven heartbeats, or increased sweating. NORTHERA should be stopped immediately if NMS is diagnosed.
- If you have coronary artery disease, irregular heartbeat, or heart failure, NORTHERA may worsen the symptoms of these disorders. Call your doctor if your symptoms become worse.
- NORTHERA may cause allergic reactions. Stop taking NORTHERA and contact your doctor right away, or go to the nearest emergency room if you experience any signs or symptoms of an allergic reaction such as: fast heartbeat, nausea, vomiting, swelling, trouble breathing, hives, or rash. NORTHERA contains tartrazine (FD&C Yellow No. 5), which may also cause an allergic reaction, especially if you have had a reaction to aspirin.
- The most common side effects with NORTHERA are headache, dizziness, nausea, and high blood pressure.
- Taking NORTHERA with other medications may cause side effects. Tell your doctor if you take prescription or over-the-counter medicines, vitamins, or herbal supplements.
- You should not breastfeed during treatment with NORTHERA.
- If you plan to become or are currently pregnant, talk to your doctor as it is not known if NORTHERA could harm your unborn baby.
- Take NORTHERA the same way each time, either with or without food.
- If you miss a dose of NORTHERA, take your next dose at the regularly scheduled time. Do not double the dose.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
- Han Z, Tian R, Ren P, et al. Parkinson’s disease and Alzheimer’s disease: a Mendelian randomization study. BMC Med Genet. 2018;19(Suppl 1):215.
- Jankovic J. Parkinson’s disease: clinical features and diagnosis. J Neurol Neurosurg Psychiatry. 2008;79(4):368-376.
- Isaacson SH, Skettini J. Neurogenic orthostatic hypotension in Parkinson’s disease: evaluation, management, and emerging role of droxidopa. Vasc Health Risk Manag. 2014;10:169-176.
- Freeman R, Wieling W, Axelrod FB, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011;21(2):69-72.
- Goldstein DS, Sharabi Y. Neurogenic orthostatic hypotension: a pathophysiological approach. Circulation. 2009;119(1):139-146.
- Freeman R. Clinical practice. Neurogenic orthostatic hypotension. N Engl J Med. 2008;358(6):615-624.
- Isaacson SH. Managed care approach to the treatment of neurogenic orthostatic hypotension. Am J Manag Care. 2015;21(13 Suppl):s258-s268.
- NORTHERA [package insert]. Deerfield, IL: Lundbeck
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