title: Refractory orthostatic hypotension in a patient with a spinal cord injury: Treatment with droxidopa.
abstract: BACKGROUND
  Orthostatic hypotension (OH) is a common complication in patients with a spinal cord injury, mainly affecting complete injuries above neurological level T6. It is generally more severe during the acute phase but can remain symptomatic for several years.
  
  
  RESULTS
  A 65-year-old male with a grade ASIA A post-traumatic cervical spinal cord injury, at neurological level C4, presenting with symptomatic refractory OH. Increased blood pressure (BP) levels and an overall clinical improvement was observed after administering an increasing dose of droxidopa. Treatment was started at a dose of 100 mg twice daily (bid), one to be taken upon rising in the morning and another one in the afternoon, at least three hours before bedtime. According to the patient's symptomatic response, each individual dose was increased by 100 mg at 48-hour intervals. Both increased mean BP levels and a subjective symptomatic improvement were evidenced at a dose of 300 mg bid.
  
  
  CONCLUSIONS
  Treatment with droxidopa increases BP levels and improves symptoms related to refractory OH using all physical and pharmacological measures available. It could therefore constitute an effective alternative treatment for OH in patients with a spinal cord injury.
authors.affiliation: a Spinal Cord Injury Unit.
authors.forename: Eva
authors.identifier: http://orcid.org/0000-0002-0678-5959
authors.initials: E
authors.lastname: Canosa-Hermida
authors.affiliation: b Pharmacy Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC). Sergas. Universidade da Coruña (UDC) , Coruña , Spain.
authors.forename: Cristina
authors.identifier: http://orcid.org/0000-0001-8555-1415
authors.initials: C
authors.lastname: Mondelo-García
authors.affiliation: a Spinal Cord Injury Unit.
authors.forename: María Elena
authors.identifier: http://orcid.org/0000-0001-5079-146X
authors.initials: ME
authors.lastname: Ferreiro-Velasco
authors.affiliation: a Spinal Cord Injury Unit.
authors.forename: Sebastián
authors.identifier: http://orcid.org/0000-0002-9810-7548
authors.initials: S
authors.lastname: Salvador-de la Barrera
authors.affiliation: a Spinal Cord Injury Unit.
authors.forename: Antonio
authors.identifier: http://orcid.org/0000-0003-1773-365X
authors.initials: A
authors.lastname: Montoto-Marqués
authors.affiliation: a Spinal Cord Injury Unit.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rodríguez-Sotillo
authors.affiliation: b Pharmacy Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC). Sergas. Universidade da Coruña (UDC) , Coruña , Spain.
authors.forename: José Ramón
authors.initials: JR
authors.lastname: Vizoso-Hermida
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015103:Droxidopa / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007024:Hypotension, Orthostatic / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D013119:Spinal Cord Injuries / Q000150:complications*
chemical_list: D000978:Antiparkinson Agents; D015103:Droxidopa
keywords: Blood pressure; Droxidopa; Orthostatic hypotension; Rehabilitation; Spinal cord injury