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A narrative review of glutathione supplementation reported that 37.5 percent of participants receiving 1.2 g of glutathione twice weekly for six weeks experienced temporary lightening, yet benefits faded within six months, and 32 percent experienced adverse events such as liver dysfunction or anaphylaxis

23 Koh JM, Lee YS, Byun CH, et al

More commonly used than droxidopa: Midodrine was approved in the 1990s (droxidopa was approved in 2014) Most clinicians have longer experience with midodrine Midodrine is available as a generic & is less expensive Droxidopa is typically reserved for use as an add-on when midodrine is ineffective, or midodrine is not tolerated due to side effects Contraindications: hypertension heart failure acute kidney failure urinary retention thyrotoxicosis pheochromocytoma Side Effects: Supine hypertension WARNING : may cause marked hypertension when the patient is supine (laying down)

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