(928) Impact of Droxidopa on Hemodynamic Support and Vasopressor Weaning in the Intensive Care Unit

Introduction: There is increasing interest in identifying novel enteral agents to maintain hemodynamics, facilitate IV vasopressor weaning and shorten time to ICU discharge in critically ill patients. Midodrine has been evaluated previously for this indication but has not demonstrated a benefit. Droxidopa is an oral agent that is directly metabolized to norepinephrine leading to vasoconstriction, which may aid in IV vasopressor weaning. However, there is very limited existing literature evaluating droxidopa for this indication in the ICU with only one retrospective review describing a benefit specifically in cardiothoracic surgery patients.

Methods: A single-center, retrospective chart review was conducted of adult patients who received droxidopa for at least 72 hours while admitted to the ICU from January 1, 2018 to June 30, 2024. Patients who were receiving droxidopa prior to admission or who had droxidopa initiated outside the ICU were excluded. The primary outcome was the change in mean arterial pressure (MAP) from the time of initiation of droxidopa to 72 hours post initiation.

Results: Eighteen patients were included in the review (average age 61.1 years, 55.6% male). Droxidopa regimens ranged from 100 mg twice daily to 500 mg three times daily with an average of 45.8 doses administered in the ICU. All patients received midodrine concurrently. At the time of droxidopa administration, 61.1% of patients were receiving IV vasopressors with an average dose of 0.1 mcg/kg/min (norepinephrine equivalent) and average MAP of 69.8. There was no difference in MAP at 24 (p=0.55), 48 (p=0.85), 72 hours (p=0.95) or 7 days (p=0.32) post droxidopa initiation. Although there was a trend towards a decreased total number of vasopressors administered at 24, 48, 72 hours and 7 days post initiation compared to the time of droxidopa initiation, there were no statistically significant differences.

Conclusions: Droxidopa did not appear to provide a benefit in improving hemodynamics or weaning vasopressors in patients in the ICU. However, these results may be limited by the small sample size. Larger scale studies are needed to further evaluate the potential role of droxidopa in the ICU.