Parkinson’s disease (PD) affects approximately one million Americans, including around 60,000 new cases diagnosed each year.1 PD is a brain disorder that may lead to symptoms such as tremors at rest, loss of balance and difficulty moving.2 It is the second leading neurodegenerative disease in older adults, second only to Alzheimer’s disease.3Courtesy Lundbeck
When patients first hear the diagnosis of “Parkinson’s disease,” typically the physical – or motor – attributes of the disease, like tremors and loss of balance, come to mind. “While the physical symptoms of PD can be challenging, there is a less often discussed, non-motor condition that can be associated with PD and other neurodegenerative conditions, which patients and their care partners should be aware of,” says Salima Brillman, M.D., Neurologist and Movement Disorder Specialist from the Parkinson’s Disease and Movement Disorders Center of Silicon Valley.
Dr. Brillman adds, “Neurogenic orthostatic hypotension, or nOH, is a condition that may go undiagnosed or misdiagnosed, since the symptoms patients experience can be nonspecific and can often be incorrectly attributed to symptoms of their underlining neurodegenerative diagnosis.”
Some of the more common symptoms of nOH, include:
- Experiencing lightheadedness upon standing or changing positions
- Experiencing dizziness when standing or changing positions
- After standing or changing positions, experiencing the feeling of blacking out
- Feeling as if you are going to faint or you do faint after standing up or changing positions
According to Dr. Brillman, “nOH is a dysfunction in a person’s autonomic nervous system which causes their blood pressure to drop significantly when trying to stand or when changing positions, causing them to feel dizzy, lightheaded or nauseous, among other symptoms. It’s more common than people may think, impacting 40% – 60% of Parkinson’s disease patients with 20% of patients becoming symptomatic.”
Gail knows this all too well. She has been living with PD for 20 years and was properly diagnosed with symptomatic nOH just over ten years ago.
“I had been experiencing dizziness and lightheadedness for most of my adult life. I would experience extreme dizziness after I would stand up and the feeling of blacking out followed me like a black cloud,” Gail explains. “This altered how I would live my daily life. I stopped doing the things I enjoyed most purely out of fear.”
“The symptoms I had been experiencing I thought were as a result of my Parkinson’s disease, which I was diagnosed with in 1999. It wasn’t until I moved to Florida and explained how I was feeling to my new neurologist that I learned that this wasn’t normal for everyone with PD. My neurologist took my blood pressure readings while in different positions, whereas my previous specialist just took it while I was seated. Once he saw the differences in readings, he knew I had nOH.”
Gail goes on to say, “I felt total relief knowing that the symptoms weren’t a part of my Parkinson’s disease and that nOH could be managed. I started on a prescription medication called NORTHERA® (droxidopa) which has helped to relieve the symptoms I felt whenever I stood up. While I was fortunate enough that NORTHERA worked for me, everyone’s experience will not be the same.” Please review the full Use for Northera and Important Safety Information below, including a boxed warning for Supine Hypertension.
“Gail is not alone,” says Dr. Brillman, “Many patients who are living with neurodegenerative conditions, like PD, experience symptoms associated with nOH. In some cases, a patient may even experience symptoms of OH prior to the hallmark symptoms associated with their primary neurodegenerative disorder.”
“If you are experiencing symptoms that resemble nOH, it’s important to talk to your doctor about them.” Dr. Brillman goes on to say, “Being informed, prepared to ask questions and providing insight into how you are feeling will benefit both you and your physician in determining a treatment plan. Materials like symptoms trackers or doctor discussion guides can lead to a more productive conversation during your appointment.”
USE OF NORTHERA (droxidopa) CAPSULES (100 mg, 200 mg, 300 mg)
NORTHERA (droxidopa) is a prescription medication used to reduce dizziness, lightheadedness, or the “feeling that you are about to black out” in adults who experience a significant drop in blood pressure when changing positions or standing (called symptomatic neurogenic orthostatic hypotension (nOH)) and who have one of the following:
- Parkinson’s disease (PD), a neurodegenerative disease that causes slowness in muscle movement as well as shaking in the hands
- Multiple system atrophy (MSA), a Parkinson’s-like disorder with more widespread effects on the brain and body
- Pure autonomic failure (PAF), a neurodegenerative disease that results in frequent drops in blood pressure upon standing
- Dopamine beta-hydroxylase deficiency, a condition where the body cannot make enough of the hormones that help regulate blood pressure
- Non-diabetic autonomic neuropathy, an inability to maintain blood pressure upon standing that can be caused by a number of rare diseases
Effectiveness beyond 2 weeks of treatment has not been established, and your doctor will decide if you should continue taking NORTHERA.
IMPORTANT SAFETY INFORMATION
• Do not take NORTHERA if you have a known allergy to NORTHERA or its ingredients.
• NORTHERA may cause high blood pressure when lying down, which could lead to strokes, heart attacks, and death. To reduce this risk of supine hypertension, take your late afternoon dose of NORTHERA at least 3 hours before going tobed.
• Neuroleptic malignant syndrome (NMS) is a rare but potentially life-threatening side effect reported with NORTHERA. Call your doctor right away and go to the nearest emergency room if you develop these signs and symptoms: high fever, stiff muscles, movements that you cannot control, confusion or problems thinking, very fast or uneven heartbeats, or increased sweating. NORTHERA should be stopped immediately if NMS misdiagnosed.
• If you have coronary artery disease, irregular heartbeat, or heart failure, NORTHERA may worsen the symptoms of these disorders. Call your doctor if your symptoms become worse.
• NORTHERA may cause allergic reactions. Stop taking NORTHERA and contact your doctor right away, or go to the nearest emergency room if you experience any signs or symptoms of an allergic reaction such as: fast heartbeat, nausea, vomiting, swelling, trouble breathing, hives, or rash. NORTHERA contains tartrazine (FD&C Yellow No. 5), which may also cause an allergic reaction, especially if you have had a reaction to aspirin.
• The most common side effects with NORTHERA are headache, dizziness, nausea, and high blood pressure.
• Taking NORTHERA with other medications may cause side effects. Tell your doctor if you take prescription or over-the-counter medicines, vitamins, or herbalsupplements.
• You should not breastfeed during treatment with NORTHERA.
• If you plan to become or are currently pregnant, talk to your doctor as it is not known if NORTHERA could harm your unborn baby.
• Take NORTHERA the same way each time, either with or without food.
• If you miss a dose of NORTHERA, take your next dose at the regularly scheduled time. Do not double the dose.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
- DeMaagd G, Philip A. Parkinson’s Disease and Its Management: Part 1: Disease Entity, Risk Factors, Pathophysiology, Clinical Presentation, and Diagnosis. PT. 2015;40(8):504-510, 532.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4517533/. Published August 2015. Accessed September 20, 2020.
- Jankovic J. Parkinson’s disease: clinical features and diagnosis. JNN&P. 2008;79:368-
376. https://jnnp.bmj.com/content/79/4/368. Published April 1, 2008. Accessed September 21, 2020.
- Han Z, Tian R, Ren P, et al. Parkinson’s disease and Alzheimer’s disease: a Mendelian randomization study. BMC Med Genet. 2018;19(Suppl 1):215. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6311900/. Published December 31, 2018. Accessed September 22, 2020.
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