Use of droxidopa for blood pressure augmentation after acute spinal cord injury: case reports
Hypotension secondary to autonomic dysfunction is a common complication of acute spinal cord injury (SCI) that may worsen neurologic outcomes. Midodrine, an enteral α-1 agonist, is often used to facilitate weaning intravenous (IV) vasopressors, but its use can be limited by reflex bradycardia. Alter...
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| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Korean Society of Critical Care Medicine
2025-02-01
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| Series: | Acute and Critical Care |
| Subjects: | |
| Online Access: | http://www.accjournal.org/upload/pdf/acc-2021-01662.pdf |
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| Summary: | Hypotension secondary to autonomic dysfunction is a common complication of acute spinal cord injury (SCI) that may worsen neurologic outcomes. Midodrine, an enteral α-1 agonist, is often used to facilitate weaning intravenous (IV) vasopressors, but its use can be limited by reflex bradycardia. Alternative enteral agents to facilitate this wean in the acute post-SCI setting have not been described. Here, we describe novel application of droxidopa, an enteral precursor of norepinephrine that is approved to treat neurogenic orthostatic hypotension, in the acute post-SCI setting. We outline the clinical course of two patients who were intolerant of midodrine due to reflex bradycardia and were successfully managed with droxidopa as an alternative treatment strategy. The addition of droxidopa avoided pacemaker placement in one patient. As such, droxidopa may be a viable enteral therapy to treat hypotension in patients after acute SCI who are otherwise not tolerating midodrine in order to wean off IV vasopressors. This strategy may avoid pacemaker placement and facilitate shorter stays in the intensive care unit, particularly for patients who are stable but require continued intensive care unit admission for IV vasopressors, which can be cost ineffective and human resource depleting. |
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| ISSN: | 2586-6052 2586-6060 |