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Northera and Dizziness

Monday April 28, 2014

The FDA has approved a new medicine that can help dizziness associated with Parkinson’s disease. Referred to as Droxidopa in clinical trials, this new drug called Northera is for neurogenic orthostatic hypotension (NOH).

Blood pressure is controlled by circulation changes tightly regulated by the nervous system. These neurologic reflexes allow pressure to stay constant, avoiding drops caused by gravity with body changes. This insures a steady blood flow to the organs and brain. When blood pressure drops with changes in body position, blood flow to the brain is reduced since a certain pressure is needed for blood to flow against gravity from heart to brain. The symptoms of dizziness is actually protective to brain function, in effect, forcing the person to sit or lie flat (or in the extreme cause fainting.) When lying flat (or sitting with the head dropped between the knees) dizziness often resolves since the brain is now at an even level or more horizontal level with the heart, improving blood flow and reducing dizziness.

Neurogenic orthostatic hypotension is described as a drop in blood pressure with change in position from either lying to sitting or sitting to standing caused by neurologic disease such as Parkinson’s. This is most commonly experienced as a brief sense of lightheadedness or dizziness when standing too fast. Falling is a concern when this problem is coupled with balance problems.

Symptoms of NOH include:

  • Dizziness when standing
  • Fatigue
  • Headache and shoulder ache
  • Visual change and feeling ‘faint’
  • Change in mentation
  • Loss of consciousness
  • Balance problems

Northera does have a black box warning describing an associated risk of increased blood pressure while lying down (supine hypertension). To avoid this it is recommended that individuals taking this drug must sleep with their head and upper body elevated. High blood pressure can be ‘silent’ without symptoms.

Northera or high blood pressure side effects include:

  • Headache
  • Nausea
  • Blurry vision
  • Increased risk of stroke or worsening of heart disease

People often use the term dizziness to describe many different problems other than blood pressure changes. There are also multiple causes of perceived dizziness even if you have NOH.

Other problems causing sensation of dizziness include:

  • Cognitive changes or processing speed sometimes referred to as ‘mental fog’ or dizziness
  • Balance problems associated with instability while standing
  • Vestibular or inner ear problems causing vertigo or sense of movement or spinning
  • Heart arrhythmia or failure
  • Low blood volume and oxygen carrying capacity caused by anemia
  • Low blood volume caused by dehydration
  • Medications that lower BP– ie. Antihypertensive medicines, Parkinson’s dopamine medicines, Narcotics, Muscle relaxants
  • Alcohol

Monique L. Giroux, MDMonique L. Giroux, MD
Medical Director, Northwest Parkinson's Foundation

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