Droxidopa Administration via Enteral Tube for Vasopressor Weaning in a Medical Intensive Care Unit

Sunday, March 22, 2026

2:30 PM - 3:30 PM Central Time

Location: Connections Central - RST 16

Caroline Popielaski, PharmD

Disclosure(s): No relevant financial relationship(s) to disclose.
KF

Keith Falsetta, PharmD, BCCCP

Clinical Pharmacy Specialist
Long Island Jewish Medical Center

Disclosure information not submitted.
KS

Krislyn Schweiger, PharmD, BCPS, BCCCP

Clinical Pharmacy Specialist
Long Island Jewish Medical Center

Disclosure information not submitted.
ZH

Zubair Hasan, MD, FCCP

Medical Intensive Care Unit Director
Long Island Jewish Medical Center

Disclosure information not submitted.
KW

Kelvin Wong, MD

Pulmonary Critical Care Medicine Physician
Long Island Jewish Medical Center

Disclosure information not submitted.
DY

Daniel Ying, DO

Pulmonary/Critical Care Attending
Mount Sinai Hospital System

Disclosure information not submitted.
PP

Parth Pancholi, MD

New York

Disclosure(s): No relevant financial relationship(s) to disclose.
XH

Xueqi Huang, MS

Assistant Biostatistician
Northwell Health

Disclosure information not submitted.

Introduction: Droxidopa is an oral norepinephrine precursor which may aid in weaning critically ill patients from intravenous (IV) vasopressors. While the package insert recommends capsules be swallowed whole, administration via enteral tube is often necessary in sedated patients. Limited data exist supporting the safety and efficacy of administration via enteral tube. This study compares whole capsule versus enteral tube droxidopa administration for IV vasopressor weaning in a medical ICU (MICU).

Methods: This retrospective study included adults admitted to the MICU at two hospitals from 01/01/2022 to 12/31/2024 who received droxidopa for ≥ 24 hours (or ≥ 3 doses) while on IV vasopressors. The primary outcome was time to IV vasopressor discontinuation. Secondary outcomes included hypotension, ICU/hospital length of stay (LOS), hypotension, vasopressor re-initiation, and safety outcomes. Multivariable logistic regression was used to adjust for confounders.

Results: Of 221 screened patients, 100 were included (46 whole capsule, 54 enteral tube). Patients receiving enteral tube droxidopa had higher APACHE IVB scores and more sedative use. A successful wean occurred in 84.7% of the whole capsule group vs. 70.3% of the enteral tube group (p = 0.09), with no significant difference after adjusting for differences in sedative use between groups (OR 0.66, p = 0.45). Time to IV vasopressor discontinuation was shorter in the whole capsule group (median 0.9 vs. 1.6 days, p = 0.01), but not significant after adjustment for sedative use (HR 0.71, p = 0.17). ICU and hospital LOS and in-hospital mortality were significantly higher in the enteral group, likely reflecting greater illness severity. Safety outcomes, including sustained hypertension, arrhythmias, behavioral changes, and enteral tube blockage were similar between groups and infrequent overall.

Conclusions: Droxidopa administration via enteral tube was not associated with significantly reduced efficacy or increased safety concerns after adjusting for confounders. Enteral administration may be a reasonable alternative in patients who cannot swallow capsules whole. However, differences in illness severity preclude definitive conclusions. Further prospective studies are needed to confirm these findings.