March 30, 2017
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Northera

"The U.S. Food and Drug Administration today approved Northera capsules (droxidopa) for the treatment of neurogenic orthostatic hypotension (NOH). NOH is a rare, chronic and often debilitating drop in blood pressure upon standing that is associate"...

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Northera

Side Effects
Interactions

SIDE EFFECTS

The following adverse reactions with NORTHERA are included in more detail in the Warnings and Precautions section of the label:

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.

The safety evaluation of NORTHERA is based on two placebo-controlled studies 1 to 2 weeks in duration (Studies 301 and 302), one 8-week placebo-controlled study (Study 306), and two long-term, open-label extension studies (Studies 303 and 304). In the placebo-controlled studies, a total of 485 patients with Parkinson's disease, multiple system atrophy, pure autonomic failure, dopamine beta-hydroxylase deficiency, or non-diabetic autonomic neuropathy were randomized and treated, 245 with NORTHERA and 240 with placebo [see Clinical Studies].

Placebo-Controlled Experience

The most commonly observed adverse reactions (those occurring at an incidence of greater than 5% in the NORTHERA group and with at least a 3% greater incidence in the NORTHERA group than in the placebo group) in NORTHERA-treated patients during the three placebo-controlled trials were headache, dizziness, nausea, and hypertension. The most common adverse reactions leading to discontinuation from NORTHERA were hypertension or increased blood pressure and nausea.

Table 1: Most Common Adverse Reactions Occurring More Frequently in the NORTHERA Group

  Study 301 and Study 302 (1 to 2 Weeks Randomized Treatment) Study 306 (8 to 10 Weeks Randomized Treatment)
Placebo
(N=132) n (%)
NORTHERA
(N=131) n (%)
Placebo
(N=108) n (%)
NORTHERA
(N=114) n (%)
Headache 4 (3.0) 8 (6.1) 8 (7.4) 15 (13.2)
Dizziness 2 (1.5) 5 (3.8) 5 (4.6) 11 (9.6)
Nausea 2 (1.5) 2 (1.5) 5 (4.6) 10 (8.8)
Hypertension 0 2 (1.5) 1 (0.9) 8 (7.0)

Note: n=number of patients. Adverse reactions that were reported in greater than 5% of patients in the NORTHERA group and with at least a 3% greater incidence in the NORTHERA group than in the placebo group were from Study 306.

Long-Term, Open-Label Trials With NORTHERA

In the long-term, open-label extension studies, a total of 422 patients, mean age 65 years, were treated with NORTHERA for a mean total exposure of approximately one year. The commonly reported adverse events were falls (24%), urinary tract infections (15%), headache (13%), syncope (13%), and dizziness (10%).

Postmarketing Experience

The following adverse reactions have been identified during post-approval use of NORTHERA. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

Cardiac Disorders: Chest pain

Eye Disorders: Blurred vision

Gastrointestinal Disorders: Pancreatitis, abdominal pain, vomiting, diarrhea

General Disorders and Administration Site Conditions: Fatigue

Nervous System Disorders: Cerebrovascular accident

Psychiatric Disorders: Psychosis, hallucination, delirium, agitation, memory disorder

Read the Northera (droxidopa capsules) Side Effects Center for a complete guide to possible side effects

DRUG INTERACTIONS

Drugs That Increase Blood Pressure

Administering NORTHERA in combination with other agents that increase blood pressure (e.g., norepinephrine, ephedrine, midodrine, and triptans) would be expected to increase the risk for supine hypertension.

Parkinson's Medications

Dopa-decarboxylase inhibitors may require dose adjustments for NORTHERA.

Non-selective MAO Inhibitors

The concomitant use of selective MAO-B inhibitors, such as rasagiline or selegiline, was permitted in the NORTHERA clinical trials. However, based on mechanism of action, the use of non-selective MAO inhibitors and linezolid should be avoided as there is a potential for increased blood pressure when taken with NORTHERA.

This monograph has been modified to include the generic and brand name in many instances.

Last reviewed on RxList: 2/24/2017

Side Effects
Interactions

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You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.


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