Northera (Droxidopa) - Oral

Warning:

Northera (droxidopa) has a warning for causing supine hypertension, meaning high blood pressure that occurs when lying down. Therefore, you must watch your blood pressure closely before starting this drug and during the time you take it, especially with any dose increase. It is recommended to rest and sleep with your upper body raised as it reduces the risk of this concern. You are at higher risk of stroke, heart attack, and even death if your blood pressure is not controlled.

What Is Northera?

Northera (droxidopa) is a prescription medication used to treat symptoms of neurogenic orthostatic hypotension in adults. It helps relieve lightheadedness, dizziness when standing, or the general feeling that you might black out.

Northera belongs to a drug class known as sympathetic agonists. Medications in this drug class activate your "fight or flight" response. These medications commonly increase your heart rate, blood pressure, or how fast you breathe. Other compounds produced in your body that are sympathetic agonists are epinephrine and norepinephrine

Northera works by mimicking epinephrine and norepinephrine. This treats orthostatic hypotension by increasing the amount of blood that reaches your brain when you first stand up.

This medication is available in capsule form to take by mouth.

Drug Facts

Generic Name: Northera

Brand Name(s): Droxidopa

Drug Availability: Prescription

Administration Route: Oral

Therapeutic Classification: Sympathetic agonist

Available Generically: No

Controlled Substance: N/A

Active Ingredient: Droxidopa

Dosage Form(s): Capsule

What Is Northera Used For?

The Food and Drug Administration (FDA) for the treatment of lightheadedness, dizziness when standing, or the general feeling that you might black out. This should only be prescribed if you have these symptoms and they are caused by:

  • Orthostatic hypotension due to a disease such as Parkinson’s disease or multiple system atrophy, a disorder when your body has issues controlling the functions of your body that are normally involuntary, such as your blood pressure, breathing, or motor control.
  • Dopamine B-hydroxylase deficiency, which is a decrease in the protein required to make epinephrine and norepinephrine.
  • Non-diabetic autonomic neuropathy, or damage to the nerves that control your involuntary movements. An example of autonomic neuropathy is heart-related neuropathy related to diabetes.

How to Take Northera

Always follow the directions from your prescriber on how to take your medication.

Generally, Northera capsules should not be chewed, opened, or crushed. Take it the same way each time you take it, either with or without food. So if you normally take it with food, continue taking it that way every time.

You should take your final dose of the day at least three hours before bedtime to help prevent high blood pressure while you sleep.

Storage

Northera should be stored in a cool, dry place at room temperature (68 F to 77 F).

In general, medications should be kept away from areas of high heat, like above your stove, or in humid environments, like your bathroom. These environments can affect how well medications work. It is also important to ensure that this medication is kept away from children and pets to prevent accidental consumption.

This medication does not have any special requirements for your pharmacist to be able to give it to you, so you should easily be able to get a refill if needed.

How Long Does Northera Take to Work?

Northera is a drug that works relatively quickly. However, your dizziness or lightheadedness will take around six hours to improve.

What Are the Side Effects of Northera?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

The most common side effects of Northera include:

Severe Side Effects

Although Northera is relatively safe, there are still severe side effects that you may experience. Call 911 or get medical help as soon as possible if your symptoms are severe or life-threatening. Severe side effects can include:

  • High blood pressure, with symptoms such as a bad headache or dizziness, passing out, or a change in eyesight.
  • Urinary tract infection (UTI), with symptoms like blood in the urine or burning or pain when passing urine.
  • Stroke can include signs such as weakness on one side of the body, trouble speaking or thinking, change in balance, drooping on one side of the face, or blurred eyesight.
  • Neuroleptic malignant syndrome (NMS) is a potentially life-threatening condition that can cause fever, muscle cramps or stiffness, severe headache, confusion, or a fast heartbeat.
  • Worsening of heart disease, irregular heart rhythm, and heart failure.

Northera does not have any side effects that occur once you stop taking the medication.

Report Side Effects

Northera may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Northera Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (capsules):
    • For neurogenic orthostatic hypotension:
      • Adults—At first, 100 milligrams (mg) three times a day (taken upon waking up in the morning, at noon, and in the late afternoon at least 3 hours before bedtime). Your doctor may adjust your dose as needed. However, the dose is usually not more than 600 mg three times a day.
      • Children—Use and dose must be determined by your doctor.

Modifications

Northera has no modifications if you are an otherwise healthy adult.

There is limited data on the use of droxidopa during pregnancy. Talk to your healthcare provider if you are pregnant. It is not recommended to breastfeed while on it due to the potential risk of side effects in breastfed infants.

Missed Dose

If you miss a dose of Northera, take it as soon as you remember. If you are close to the next dose, then you should skip the missed dose and take your next scheduled one. Do not take more than one dose at a time.

Overdose: What Happens If I Take Too Much Northera?

If you take too much Northera, you are most likely going to experience blood pressure high enough to be classified as hypertensive crisis.

There is no available antidote for a Northera overdose. To treat hypertensive crisis, it is important to immediately stop taking the medication that caused it and treat the overdose symptoms. Generally, treatment will involve lowering and controlling blood pressure.

What Happens If I Overdose on Northera?

If you think you or someone else may have overdosed on Northera, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Northera, call 911 immediately.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

It is very important that your doctor check your progress at regular visits. This will allow your doctor to see if the medicine is working properly and to check for unwanted effects caused by this medicine. You may also need to monitor your blood pressure at home before, during, and after treatment.

This medicine may increase your risk of having supine hypertension, which can lead to stroke or heart attack. You doctor will tell you to rest or sleep in an upper body elevated position and monitor your blood pressure. If you notice changes in your blood pressure, tell your doctor right away.

This medicine may cause confusion, fever, and worsening of heart or blood vessel problems. Tell your doctor right away if you have these conditions.

If your condition does not improve within 2 weeks, or if it become worse, check with your doctor.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Take Northera?

Generally, Northera is safe for most people to take.

However, it shouldn’t be used outside of its approved indications. It is also not recommended to take while pregnant or breastfeeding. Consult your healthcare provider if you are pregnant or plan to become pregnant while being treated.

What Other Medications Interact With Northera?

Northera can interact with other medications. Tell your healthcare provider about any other medicines you take or plan to take, including over-the-counter (OTC) nonprescription products, vitamins, herbs, supplements, and plant-based medicines.

Northera can interact with other drugs that also increase blood pressure. Taking these medications together can increase the risk of supine hypertension. Examples of drugs that can increase blood pressure are:

Northera also interacts with drugs used to treat Parkinson's disease called dopa-decarboxylase inhibitors, including Sinemet (carbidopa and levodopa). If you are taking any of these medications, your healthcare provider may adjust your dosage of Northera.

This is not a complete list of drug interactions, and others can occur. Tell your healthcare provider about any other medicines you take or plan to take, including OTC nonprescription products, vitamins, herbs, supplements, and plant-based medicines. Ask them for a full list of potential interactions.

What Medications Are Similar?

Other medications that are used for the treatment of orthostatic hypotension include:

This is a list of drugs that are similar to Northera. It is NOT a list of drugs recommended to take with Northera. In fact, you should not take these drugs together. Talk to your pharmacist or your healthcare provider if you have questions.

Frequently Asked Questions

  • How expensive is Northera? Is there a way to get help paying for it?

    Northera is a relatively expensive specialty medication, and depending on your insurance, the price will vary. If you have trouble affording your medication, you may be eligible for savings cards available through the manufacturer. Ask your healthcare provider or pharmacist about prescription assistance programs.

  • Are there non-pharmacological ways to treat orthostatic hypotension?

    The easiest way to reduce orthostatic hypotension is to correct the factors causing the symptoms. This can include changing medication doses, increasing water and salt in your diet, standing up more slowly, or increasing exercise.

  • How can I manage the side effects associated with Northera?

    Nausea, vomiting, and dizziness are common side effects of Northera. If you have any of these side effects, try taking your doses with food and drink plenty of water.

How Can I Stay Healthy While Taking Northera?

To stay healthy while taking Northera, take it as directed by your healthcare provider.

Since Northera can raise your blood pressure, monitor your blood pressure levels throughout treatment. Rest and sleep in an elevated position to reduce the risk of supine hypertension. Also, avoid taking your last dose of the day too close to bedtime.

It may not be easy to take it consistently at first if you have trouble remembering to take your medications. However, to effectively treat your orthostatic hypotension, you must adhere to your prescribed dosing schedule. Try using a medication app reminder or calendar on your phone to alert you when to take your doses.

Additionally, it's always important to get plenty of rest, stay hydrated, and eat a healthy diet.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

The author would like to recognize and thank Chong Yol Gacasan Kim for contributing to this article.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Food and Drug Administration. Northera label.

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  4. Aronow WS. Treatment of hypertensive emergencies. Ann Transl Med. 2017;5(Suppl 1):S5. doi:10.21037/atm.2017.03.34

  5. Palma JA, Kaufmann H. Management of orthostatic hypotension. Continuum (Minneap Minn). 2020;26(1):154-177. doi:10.1212/CON.0000000000000816