Droxidopa for Facilitating Vasopressor Weaning in Persistent Hypotension

Introduction: ICU patients may have prolonged hypotension without end-organ damage, extending vasopressor use. Midodrine is the most widely studied oral agent but has limited efficacy in decreasing vasopressor duration. Droxidopa is another potential oral option for vasopressor weaning as it is metabolized to norepinephrine, but data supporting its use are limited. This study aims to describe the efficacy of droxidopa for blood pressure support to facilitate vasopressor discontinuation.


Methods: A single-center, retrospective review of patients admitted to an ICU at an academic medical center who received droxidopa for persistent hypotension requiring vasopressors from June 1, 2024, through May 31, 2025 was performed. Patients were excluded if droxidopa was continued from home medications or initiated for indications other than vasopressor liberation.


Results: A total of 49 patients were reviewed and 27 met inclusion criteria. At the time of droxidopa administration, concomitant midodrine therapy was utilized in 88% of patients. The median initial daily dose of droxidopa was 300 mg, which was titrated to a median of 1,200 mg. Droxidopa was initiated in patients with a median systolic blood pressure (SBP) of 103 mmHg, mean arterial pressure (MAP) of 69, and vasopressor requirement of 0.09 mcg/kg/min of norepinephrine equivalents (NEE). The primary endpoint of vasopressor discontinuation at day 7 was achieved in 8 patients (29%). Median initial vasopressor dose was lower in patients who achieved vasopressor liberation (0.04 mcg/kg/min NEE vs 0.095 mcg/kg/min NEE). Twelve patients on continuous renal replacement therapy were able to be converted to intermittent hemodialysis. Median hospital and ICU stays were 36 and 26 days, respectively. Two patients (6%) reported adverse drug reactions leading to droxidopa discontinuation. Four patients (15%) were discharged on droxidopa and 6 patients (22%) required hospital readmission within 30 days.


Conclusions: In this retrospective analysis, initiation of droxidopa led to vasopressors discontinuation by day 7 in a small proportion of patients. Though droxidopa was well tolerated, larger comparative trials are warranted to elucidate its potential role in vasopressor weaning strategies.