Neurogenic Orthostatic Hypotension (nOH)

Neurogenic orthostatic hypotension (nOH) is a common symptom of Parkinson’s. nOH refers to a drop in blood pressure when changing position, especially when standing up. nOH is due to the autonomic nervous system failing to maintain blood pressure when changing position. The most common symptom of nOH is light-headedness, but nOH can also cause blurry vision and cognitive changes that are worse when standing up. Non-pharmacological changes can be very effective. These include increasing fluid intake, increasing salt and caffeine intake, wearing compression stockings or an abdominal binder, and raising the head of the bed during sleep. Medications can also improve nOH in people with Parkinson’s. Possible side effects include high blood pressure when lying down (supine hypertension).

Generic Name
Trade Name
Patient Assistance
Droxidopa Northera Mechanism is increasing circulating norepinephrine. Only medication specifically indicated for symptomatic nOH. Product Website Lundbeck Patient Financial Assistance More Information
Midodrine ProAmatine Mechanism is blood vessel constriction. Possible side effects include tingling, itchiness, and hair standing up. Prescribing Information
Fludrocortisone Florinef Mechanism is increased fluid retention. Should not be used by people with heart failure. Possible side effects include leg swelling. Requires testing for blood potassium levels.

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