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Midodrine vs Droxidopa vs Mestinon

Denise

Senior Member
Messages
1,095
I am very confused that doctors seem to be saying that Northera (droxidopa) is not approved.
This is an FDA press release from February of this year:
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm386311.htm
and this is from the manufacturer in September of this year:

As for the drug not being widely available, my understanding is that it sometimes takes pharmaceutical companies a while to get production or distribution up to speed.
 

Sushi

Moderation Resource Albuquerque
Messages
19,935
Location
Albuquerque
I really don't recall ever feeling thirsty and now I am worried this is very abnormal? :confused:

I'm no expert here but I have heard that people who have been dehydrated for a long time lose the sense of being thirsty. I never used to feel thirsty (and didn't drink much) until my doctors told me that I was dehydrated and asked me to set out my water quota for the day in a jug as a reminder to drink it all up.

After a while I noticed that I had started to feel thirsty and now I can rely on thirst to tell me when to drink. No idea if you are in the same situation or would experience the same sort of thing.

Sushi
 

Gingergrrl

Senior Member
Messages
16,171
I am very confused that doctors seem to be saying that Northera (droxidopa) is not approved.
This is an FDA press release from February of this year:
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm386311.htm
and this is from the manufacturer in September of this year:

As for the drug not being widely available, my understanding is that it sometimes takes pharmaceutical companies a while to get production or distribution up to speed.

@Denise I am confused about this, too, b/c my cardio said that Droxidopa was FDA approved last month (maybe he didn't know it happened in Feb?) but if this is the case, why can it not be picked up at a regular pharmacy like CVS? I am certainly not paying an $836/mo co-pay but even if I was wealthy and had the ability to, they said it is not available except through this special program and the company/drug reps mail it to you. Maybe in other countries it is different than in the US? I can't make sense of it either.

ETA- Denise, can you remind me if you have tried Droxidopa? I know we talked about it in a post last month but don't recall the specifics.
 
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Gingergrrl

Senior Member
Messages
16,171
I'm no expert here but I have heard that people who have been dehydrated for a long time lose the sense of being thirsty. I never used to feel thirsty (and didn't drink much) until my doctors told me that I was dehydrated and asked me to set out my water quota for the day in a jug as a reminder to drink it all up.

After a while I noticed that I had started to feel thirsty and now I can rely on thirst to tell me when to drink. No idea if you are in the same situation or would experience the same sort of thing.

Sushi

@Sushi This could be true in my case and I was severely dehydrated during mono and probably have been ever since but just didn't know it. My water quota is supposed to be eight cups a day but I almost never even come close. How long did it take you to feel thirst after you set out that jug as a reminder?
 

Sushi

Moderation Resource Albuquerque
Messages
19,935
Location
Albuquerque
How long did it take you to feel thirst after you set out that jug as a reminder?

Probably after a few months of "drinking it all up." Have you tried drinking about 500 ml of an electrolyte solution before you get out of bed in the a.m.? Several have mentioned that this really works for them. They make that "drinking time" into something they enjoy by listening to music, reading, whatever is relaxing and enjoyable.

Sushi
 

SDSue

Southeast
Messages
1,066
It is also easier for me to drink things that are carbonated
This is why I live on LaCroix and other bottled sparkling water (I prefer glass bottles - fewer toxins) since getting ill. Regular water makes my stomach very upset and gives me reflux - it seems to just sit in my stomach too long. I even mix my Nuun electrolytes in sparkling water for this reason.
 

SDSue

Southeast
Messages
1,066
Side note: I am thirsty ALL THE TIME!!! (I'd think diabetes insipidus but recently did a 24 hour catch and apparently ruled it out).
 

Denise

Senior Member
Messages
1,095
@Denise I am confused about this, too, b/c my cardio said that Droxidopa was FDA approved last month (maybe he didn't know it happened in Feb?) but if this is the case, why can it not be picked up at a regular pharmacy like CVS? I am certainly not paying an $836/mo co-pay but even if I was wealthy and had the ability to, they said it is not available except through this special program and the company/drug reps mail it to you. Maybe in other countries it is different than in the US? I can't make sense of it either.

ETA- Denise, can you remind me if you have tried Droxidopa? I know we talked about it in a post last month but don't recall the specifics.

I have not tried droxidopa (brand name Northera) but I do know some patients on it.

I asked about their experience with the manufacturer and specialty pharmacy and they indicated that it was pretty good - especially the manufacturer (I believe it was via a dedicated support center). From what I was told, the people from the support center were surprisingly helpful.

As for cost, I was told that there is a patient assistance program for droxidopa - perhaps the rep who calls you (is that someone from the support center perhaps?) can send you materials in writing.

I do not know why droxidopa is only available through a specialty pharmacy (and not a local or 90 day pharmacy). I found this link about specialty pharmacies. http://www.pharmacist.com/specialty-pharmacy
 

Valentijn

Senior Member
Messages
15,786
My water quota is supposed to be eight cups a day but I almost never even come close.
I'm supposed to drink 2 liters per day, so I keep a water jug next to the couch and/or bed downstairs so I don't have to walk to the kitchen to refill my glass.

I drink fairly well without prompting, so I tend not to keep close track, but it would be easy to just fill it every morning and approach drinking water just like taking a medication. If you did something like that, then you could glance at it during the day, and see if you are about where you should be for that time of day - half-full at noon, less than 1/4 full by dinner, etc.
 

Gingergrrl

Senior Member
Messages
16,171
@Denise

I have not tried droxidopa (brand name Northera) but I do know some patients on it.

Thank you and I just got off the phone with the Nothera (Droxidopa) Support Center and although they were very nice, I went in circles and did not get a lot of info.

I asked about their experience with the manufacturer and specialty pharmacy and they indicated that it was pretty good - especially the manufacturer (I believe it was via a dedicated support center). From what I was told, the people from the support center were surprisingly helpful.

They explained that it is only available through a specialty pharmacy, like you said, and for whatever reason, it will never be made available through regular pharmacies like CVS. The only option is to have them mail you a free 14 day supply and follow the tapering schedule which I am not going to do b/c my body would never tolerate it. You would have to take three pills on the very first day and then every other day double the dose and my body just does not work that way.

As for cost, I was told that there is a patient assistance program for droxidopa - perhaps the rep who calls you (is that someone from the support center perhaps?) can send you materials in writing.

You are correct and I was told that I qualify for the program so the medication would be free. However, I am switching insurances in Jan (to a different plan through Covered CA) but I don't think that would change anything.

My frustration is that my cardio told me that he has never prescribed this med and has no experience with it. He wanted me to talk to the Noethera Center reps but they could only talk about logistics and not medical questions. From a logistical perspective we decided that I will keep my name on the list and after I see my cardio in January and also get my new insurance, I will call them back if I decide to pursue this med.

He transferred me to a pharmacist and said she could answer the medical questions but unfortunately she just kept referring me back to my own doctor (who has never prescribed this med before!!!) I asked her generic questions that were not about me re: the mechanism of how Droxidopa works, what are the side effects, how does it compare to Midodrine, etc, but she really could not provide much info.

I asked what symptoms Droxidopa targets and she said it was made for patients with Parkinsons Disease whose BP drops when they stand and they get dizzy and pass out. This is NOT me and I told her my symptoms (consistent low BP regardless of position, low blood volume, severe tachycardia without beta blocker, shortness of breath, etc) and she seemed to imply that I would then be taking it "Off label."

I asked her about the black box and other warnings which include heart attacks, arrythmias, congestive heart failure, and NMS (neuroleptic malignant syndrome- which can be fatal!) and she said she could not give me any statistics or percentages and that "Every med comes with some risk" and they had to list those due to "Post marketing cases in Japan." She admitted that U.S. doctors do not yet have experience prescribing this med.

Overall, while both people I spoke with were nice, I am more convinced than ever that this is not the med for me. Maybe if it is on the U.S. market for a few years and doctors get experience prescribing it AND can write the prescription in any way they choose (i.e. try one pill a day for a week and if okay, then increase to two pills, etc) then I am not going to be a guinea pig.

I don't mean to sound angry but this was a frustrating phone call!
 

Gingergrrl

Senior Member
Messages
16,171
I'm supposed to drink 2 liters per day, so I keep a water jug next to the couch and/or bed downstairs so I don't have to walk to the kitchen to refill my glass.

I drink fairly well without prompting, so I tend not to keep close track, but it would be easy to just fill it every morning and approach drinking water just like taking a medication. If you did something like that, then you could glance at it during the day, and see if you are about where you should be for that time of day - half-full at noon, less than 1/4 full by dinner, etc.

@Valentijn I love this idea but am not strong enough to lift and pour a water jug and I try to alternate the fluids with Pedialyte, sparkly water, coconut water, etc, and know I could never tolerate eight cups of plain water.

I am trying to brainstorm a system that could work for me though b/c your idea is great.
 

Valentijn

Senior Member
Messages
15,786
Gingergrrl said:
I am trying to brainstorm a system that could work for me though b/c your idea is great.
Could you pour your daily liquids into 8 glasses or other containers at the start of the day? Though that would make for a lot of glasses to wash :p Or maybe 4 larger mugs/containers which each have a couple glasses worth of each liquid that you drink.
 
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Gingergrrl

Senior Member
Messages
16,171
Could you pour your daily liquids into 8 glasses or other containers at the start of the day? Though that would make for a lot of glasses to wash :p Or maybe 4 larger mugs/containers which each have a couple glasses worth of each liquid that you drink.

@Valentijn For some reason, it credited my above quote in your post to Sue as if she said it and not sure why?!

I like your idea and I have plastic cups (for now b/c they are lighter to carry) so I wouldn't have to wash anything. I just don't want to pour things out of bottles into cups and then potentially waste them. I am thinking maybe of making some kind of check box system for fluids in the notebook where I track my meds so I check off a box for each cup I drink and write down what it was. My whole notebook is a big mess but I've been wanting to re-do it and could add something like this so I actually see what I have drank that day.
 

Gingergrrl

Senior Member
Messages
16,171
How about a "no wasting rule" that would encourage you to drink them up? :)Do you get unpleasant symptoms from drinking liquids or is it just an "unpleasant job?"

Sushi

@Sushi I feel like I could make that rule in my head but then still not follow it :D. I am not sure if I get any unpleasant symptoms from drinking but I just don't enjoy it and find it very difficult. Although on days that I have tried fasting (for different reasons and not recently) then it was much easier to drink liquids all day without the burden of having to eat food.
 

Sing

Senior Member
Messages
1,782
Location
New England
I am chuckling over this little conversation about water drinking. I have nothing to add to the discussion of the specific problem except to share that I too have trouble following protocols and trying to control too much of my behavior. It already seems as if I have an increasing number of things to do each day to manage my body and compensate for physical and mental limitations. I don't like having to be focussed on these minor things so much of the time. I rebel against micro-managing!
 

charlie1

Senior Member
Messages
315
Location
Canada
Gingergrrl, We spoke in the past but its been a long time since I've been on PR. I've read the posts and am frustrated to hear all the hoops that must be jumped through regarding the Droxidopa. Although it isn't approved in Canada, I was hoping I could somehow get a script for it in Michigan (we live on the border) and then go to Walgreens or CVS but I can see now that this will be very challenging, if not impossible. Seeing as I"m not an American citizen, I don't know if I'd be considered to be part of the trial although like you, I am nervous of not being able to titrate the dosage if I feel its required.

Mestinon helped me for awhile but I am still having low blood pressure readings similar to yours. Either my symptoms will not change when I go off of it (I intend to do an experiment to see if its helping at all anymore), or will in fact worsen.

Although Florinef gave me headaches, perhaps I need to try it again in case blood volume is my problem. Midodrine caused my heart rate to fall into the 30s so I cannot take it.
 

Gingergrrl

Senior Member
Messages
16,171
Gingergrrl, We spoke in the past but its been a long time since I've been on PR.

@charlie1 It is great to hear from you and I definitely remember speaking with you in the past! I tried to contact you in another thread to ask you more about Mestinon but you must not have been on PR at that time.

I've read the posts and am frustrated to hear all the hoops that must be jumped through regarding the Droxidopa.

Yes, it is a big production to get Droxidopa here and for whatever reason, it is only available through a special program at one specialty pharmacy. I would have been able to get it but in my case, I decided to postpone and stick with the Midodrine both because of insurance and medical reasons (as I explained earlier in this thread.)

Although it isn't approved in Canada, I was hoping I could somehow get a script for it in Michigan (we live on the border) and then go to Walgreens or CVS but I can see now that this will be very challenging, if not impossible.

It is not available through CVS or Walgreens in the U.S. (only the program I mentioned) but I have no idea how it might work in Canada.

Seeing as I"m not an American citizen, I don't know if I'd be considered to be part of the trial although like you, I am nervous of not being able to titrate the dosage if I feel its required.

That was a big part of my concern and unless I could titrate the dosage on my own through a "low and slow" trial, I knew this protocol would never work for me.

Mestinon helped me for awhile but I am still having low blood pressure readings similar to yours. Either my symptoms will not change when I go off of it (I intend to do an experiment to see if its helping at all anymore), or will in fact worsen.

My BP on most days recently tends to be in the mid to upper 90's above the mid to upper 60's. Keep me posted what happens with the Mestinon. Also, can you remind me, was it prescribed for BP or to control tachycardia (or both?)

Although Florinef gave me headaches, perhaps I need to try it again in case blood volume is my problem.

Florinef gave me headaches and made me feel much sicker overall. I tried it for several months but finally stopped it in Sept. I do better trying to raise blood volume by drinking Vitalyte and taking salt stick tablets.

Midodrine caused my heart rate to fall into the 30s so I cannot take it.

For whatever reason, I have never tried any med yet that has dropped my HR too low. I have had meds that dropped my BP to very scary lows but never my HR. For me Midodrine and Atenolol seem to be the right combination to resolve my tachycardia (which can go into 160 or 170 bpm without meds) but keep my BP in the 90's over 60's.

My problem still remains shortness of breath and these angina type episodes that we suspect are microvascular angina spasms and cause chest pressure or in bad episodes actual chest pain. I see my cardio again on Jan 6th and will see what he recommends. I have nitroglycerin spray that I still have not tried (too afraid :nervous:) but if I have another really bad episode, I think I will try it. I am also trying Magnesium by nebulizer which is helping my shortness of breath.

Great to hear from you again Charlie!
 

charlie1

Senior Member
Messages
315
Location
Canada
@ Gingergrrl - Happy New Year ! May 2015 be the year of better health for all of us!

My BP on most days recently tends to be in the mid to upper 90's above the mid to upper 60's. Keep me posted what happens with the Mestinon. Also, can you remind me, was it prescribed for BP or to control tachycardia (or both?)

I have been off Mestinon for 2 days now and have not noticed anything different than when on it. I suspect I'll d/c it all together and start taking DHEA soon to see if that gives me more strength.(I'm extremely low in dhea).

The Mestinon helped my tachycardia within days! Because I am often bradycardic(pulse in the 50's), I don't get the high heart rate that you do. Regardless, my TTT showed an increase of >30 bpm so a dx of POTS was given and the Mestinon was prescribed ( 180 mgSR once/day). Since that time, my problem is now more with the low blood pressure which is not only found when standing, I'm just chronically low. Yesterday afternoon was 83/58 which is not at all unusual although more often it's in the mid 90/s over low 60's. The light headedness and weakness that accompanies the LBP is a big issue with me, hence the need to find drug aid since the usual suggested home measures aren't helping enough.

I don't know if it's just a matter of time that has made my symptoms not as severe as 3 yrs ago or if the Mestinon is in fact the reason. It might be worth a try for you to try it b/c I was in my backyard walking the dog within days of taking it! Prior to that I was couch bound. Although still weak, I stayed close to symptom free for about 6 wks and then symptoms started being felt again which I now think was due to blood pressure plummeting....the feeling of tachycardia and low blood pressure are so similar (to me). My neurologist suggested I go for counseling since he didn't think anything else could be done for me! Out of desperation, a year ago I complied but therapy talk sessions have not done anything to improve my symptoms. Go figure....

Hopefully this information helps you Gingergrrl. Let's keep in touch.