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Droxidopa in Critical Care: A Systematic Review of an Emerging Off-Label Practice
Carlos Valladares1, Franklyn Vega Batista2, Marc Faltas3
1Department of Pulmonary and Critical Care, University of Miami, Miami, 33136, Florida, USA, miami.edu.
Critical Care Research and Practice
|December 22, 2025
Summary
Droxidopa may help wean intensive care unit (ICU) patients off vasopressors, but current evidence is limited. Further research is needed to confirm its efficacy and safety in critically ill populations.
Area of Science:
- Critical Care Medicine
- Pharmacology
- Clinical Research
Background:
- Prolonged use of intravenous (IV) vasopressors in critically ill patients is linked to significant complications.
- Droxidopa, a norepinephrine precursor, is being explored for facilitating vasopressor weaning in intensive care units (ICUs).
Purpose of the Study:
- To systematically review the efficacy and safety of droxidopa for vasopressor weaning in ICU patients.
- To synthesize current evidence on droxidopa's role in managing critically ill patients requiring vasopressor support.
Main Methods:
- A systematic review adhering to PRISMA guidelines was conducted.
- Searched databases included PubMed, Embase, Cochrane, and Web of Science through April 2025.
- Included studies reported primary clinical data on droxidopa use in ICU patients, assessing outcomes like time to vasopressor discontinuation, duration of droxidopa use, ICU length of stay (LOS), and ICU mortality.
Main Results:
- Seven studies with 161 ICU patients were included.
- Time to vasopressor discontinuation ranged from 29 to 120 hours; droxidopa use duration ranged from 87 to 192 hours.
- Findings are based on small, retrospective studies with limited generalizability due to variations in dosing and outcome reporting.
Conclusions:
- Droxidopa may aid in vasopressor weaning for critically ill patients, but evidence is limited and of very low certainty.
- Heterogeneity in study design, patient selection, and outcome reporting necessitates cautious interpretation.
- Further high-quality research is warranted to establish droxidopa's definitive role in ICU vasopressor management.
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