Hypertensive Crisis with Vasogenic Cerebral Edema Induced by Droxidopa in a Patient with Pure Autonomic Failure

By
Min-Ku Kim
Sung-Sik Kim
Jong-Gyu Baek
August 20, 2026

Frontiers In Neurology

Background

Pure autonomic failure (PAF) is a rare neurodegenerative disorder characterized by significant blood pressure lability and neurogenic orthostatic hypotension. Droxidopa is commonly used for symptomatic management of neurogenic orthostatic hypotension, but its safety profile in patients with advanced autonomic dysfunction is not well established. Understanding the risks associated with droxidopa is crucial for optimizing treatment strategies in this vulnerable population.

Data Highlights

No numerical data or trial data presented in the article.

Key Findings

A 60-year-old female with advanced PAF experienced a hypertensive emergency after starting droxidopa.
The patient exhibited significant blood pressure lability and preexisting supine hypertension prior to droxidopa initiation.
Low-dose droxidopa led to reversible vasogenic cerebral edema, a rare complication in this context.
Careful dose titration and stringent blood pressure monitoring are essential when prescribing droxidopa in patients with advanced autonomic dysfunction.
Previous treatments for neurogenic orthostatic hypotension, including midodrine, were ineffective in this patient.

Clinical Implications

Clinicians should be aware of the potential for severe hypertensive crises when initiating droxidopa in patients with advanced autonomic failure.

Conclusion

This case highlights the need for vigilant monitoring and dose adjustments in patients with pure autonomic failure receiving droxidopa.

Hypertensive Crisis with Vasogenic Cerebral Edema Induced by Droxidopa in a Patient with Pure Autonomic Failure