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Midodrine

    Brands

    DEA Class;  Rx

    Common Brand Names; ProAmatine, Orvaten

    • Alpha1 Agonists

    Alpha-1 selective adrenergic agonist; increases peripheral vascular resistance; arteriolar and venous tone increases and results in a rise in sitting, standing, and supine systolic and diastolic blood pressure in patients with orthostatic hypotension

    Indicated in Symptomatic Orthostatic Hypotension, Stress Incontinence (Off-label)

    Severe organic heart disease, supine HTN, acute renal disease, urinary retention, pheochromocytoma, thyrotoxicosis

    • Paresthesia (18%)
    • Piloerection (13%)
    • Pruritus (13%)
    • Supine hypertension (7-13%)
    • Urinary retention or urgency (up to 13%)
    • Chills (5%)
    • Pain, including abdominal pain (5%)
    • Rash (2%)
    • <1%
    • Anxiety
    • Canker sore
    • Confusion
    • Dizziness
    • Dry skin
    • Erythema multiforme
    • Facial flushing
    • Flushing
    • Headache
    • Hyperesthesia
    • Insomnia
    • Intracranial pressure increased
    • Nausea
    • Somnolence
    • Weakness
    • Xerostomia

    May slow heart rate primarily due to vagal reflex; use caution when administering concomitantly with negative chronotropes, including digoxin, beta blockers, or other agents that decrease heart rate; discontinue use if signs or symptoms of bradycardia occur

    Risk of hypertension increases with concomitant administration of drugs that increase blood pressure (phenylephrine, pseudoephedrine, ephedrine, dihydroergotamine, thyroid hormones, or droxidopa); avoid concomitant use of drugs that increase blood pressure; if concomitant use cannot be avoided, monitor blood pressure closely

    Avoid concomitant administration with MAO inhibitors or linezolid

    It is essential to monitor supine and sitting blood pressures in patients receiving therapy; uncontrolled hypertension increases risk of cardiovascular events, particularly stroke

    Avoid concomitant use with treatment agents that may cause vasoconstriction

    Use caution in patients with diabetes mellitus, vision problems, and renal or hepatic impairment

    Take drug no later than 6 pm and 3-4 hr before bed to minimize supine HTN

    Pregnancy category: C

    Lactation: Not known if excreted into breast milk; avoid

    Adults

    Symptomatic Orthostatic Hypotension

    2.5-10 mg PO q8hr

    Usual dose: 10 mg PO q8hr

    Doses greater than 30 mg/day have not been studied; should not exceed 40 mg/day

    Stress Incontinence (Off-label)

    2.5-5 mg PO q8-12hr

    Pediatric

    Safety & efficacy not established

    Midodrine hydrochloride

    tablet

    • 2.5mg
    • 5mg
    • 10mg