Dose Response to the Norepinephrine Precursor Droxidopa in Hypotensive Individuals With Spinal Cord Injury
Hypotension, Orthostatic, Hypotension, Spinal Cord Injuries
About this trial
This is an interventional treatment trial for Hypotension, Orthostatic focused on measuring Hypotension, Spinal Cord Injury, Droxidopa, Northera, Neurogenic Orthostatic Hypotension
Eligibility Criteria
Inclusion Criteria:
Study 1:
- Male or Female, age 18 to 89 with traumatic SCI.
SCI Subjects (n=40):
- Any level of injury;
- Any American Spinal Injury Association Impairment Scale (AIS) grade of SCI;
- Non-ventilator dependent
- Primarily wheelchair dependent for mobility;
- Duration of injury < 1 year
Low Blood Pressure:
- Systolic BP less than 110 mmHg and/or diastolic BP less than 70 mmHg for males.
- Systolic BP less than 100 mmHg and/or diastolic BP less than 70 mmHg for females.
- Primary Language is English.
Able to provide informed consent
Study 2:
- Male or Female, age 18 to 89 with traumatic SCI.
SCI Subjects (n=40):
- Any level of injury;
- Any AIS grade of SCI;
- Non-ventilator dependent
- Primarily wheelchair dependent for mobility
- Duration of injury < 1 year
Low Blood Pressure:
- Systolic BP less than 110 mmHg and/or diastolic BP less than 70 mmHg for males.
- Systolic BP less than 100 mmHg and/or diastolic BP less than 70 mmHg for females.
- Primary Language is English.
- Able to provide informed consent
- Showed a normotensive blood pressure in response to Droxidopa during study 1.
Exclusion Criteria:
- Current illness or infection
Individuals with frequent or severe autonomic dysreflexia:
- More than 3 symptomatic events per week
- BP ≥140/90 mmHg
- Significant adverse subjective symptoms reporting
- Hypertension
- Any neurological condition other than SCI (Alzheimer's disease, dementia, stroke, multiple sclerosis, Parkinson's disease, etc.)
- History of epilepsy or other seizure disorder
- History of traumatic brain injury (TBI)
- Liver or kidney disease
- Bladder problems including blockage of the urine and/or weak urine stream.
- Diagnosis of a psychiatric disorder such as schizophrenia or bipolar disorder
- Known artery disease, heart failure, Atrio-ventricular block, and irregular heartbeat
- Any allergies to droxidopa, asprin, polyethylene oxide, polyethylene glycol, hydroxypropyl cellulose, butylated hydroxytoluene, magnesium stearate, hypromellose, yellow ferric oxide, and red ferric oxide
- Major surgery in the last 30 days
- Illicit drug abuse in the past 6 months
- Pregnant
Your prescription medications will be reviewed by the study investigators and research staff. If you are currently taking medications to treat any of the following please make the investigators aware:
d. Depression, Schizophrenia, Attention Deficit Hyperactivity Disorder (ADHD) e. Pain (opioids) f. Infection or illness (antibiotics) g. Erectile dysfunction (Viagra, Cialis, etc.) h. Overactive bladder i. High or low blood pressure j. Migraine headaches k. Malaria l. asthma
Sites / Locations
- James J. Peters Veteran's Affair Medical Center
- The Icahn School of Medicine at Mount Sinai
Arms of the Study
Arm 1
Arm 2
Experimental
Placebo Comparator
Study 1: Dose Optimization of Northera
Study 2: Blinded Placebo & Northera
Subjects will be administered oral droxidopa in a dose escalation, open-label manner beginning with 200 mg. The dose will be adjusted upwards by 100 mg on subsequent visits until average Systolic Blood Pressure (SBP) recorded 60-120 minutes after dose administration is 111-139 mmHg in males and 101-139 mmHg in females, sustained elevation (≥ 30 consecutive minutes) in seated SBP ≥ 140/100 mmHg, maximum dose of 800 mg is reached without adequate SBP response. Subjects will visit the testing laboratory on as few as 1 (200 mg) and as many as 7 (800 mg) days. Seated cardiovascular assessments will be monitored and recorded at 15-minute intervals for 4-hours, and the side effects questionnaire will be administered hourly during the 4-hour study. Each study visit will take about 5 hours.
Participants will then be administered either oral optimal dose of Northera (Droxidopa) or matching placebo in a double-blinded manner and will remain in the supine position for 60 minutes. Subjects will remain in their wheelchair for instrumentation, which will include: 1) ECG, 2) brachial BP, 3) finger arteriolar BP and 4) Cerebral Blood Flow velocity (CBFv).