Midodrine
Orthostatic Hypotension, Urinary Incontinence
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Drug Status
Government Approvals
US(FDA), UK(BNF)
WHO Essential Medicine
NO
Known Teratogen
NO
Pharmaceutical Class
Alpha-Adrenergic Agonist
Controlled Drug Substance
NO
Midodrine
Summary
Midodrine is primarily used to treat a condition called orthostatic hypotension, which is a significant drop in blood pressure when standing up, causing symptoms like dizziness or fainting. It is also used for certain types of low blood pressure related to autonomic dysfunction or severe kidney disease.
Midodrine works by stimulating certain receptors in blood vessels, causing them to tighten or constrict. This increases blood pressure, particularly when standing, which helps prevent dizziness and fainting.
The usual starting dose for adults is 2.5 mg, taken three times a day. The dosage may be increased gradually, up to a maximum of 10 mg per dose, depending on your response and tolerance. It is taken orally, during the day, with the last dose at least 4 hours before bedtime.
Common side effects of Midodrine include itching, scalp tingling, and urinary retention. More serious effects can include increased blood pressure while lying down, which may cause headaches or vision problems. Rare but serious reactions include heart problems like irregular heartbeats.
Midodrine should not be used in patients with high blood pressure, heart disease, or kidney problems. It is also not recommended for those with urinary retention, certain adrenal gland tumors, or thyroid disorders. Caution is needed in individuals with a history of stroke or irregular heartbeats.
Indications and Purpose
How does Midodrine work?
Midodrine works by stimulating alpha-1 receptors in blood vessels, causing them to constrict (tighten). This vasoconstriction increases blood pressure, particularly in the upright position, which helps prevent dizziness and fainting caused by orthostatic hypotension. By enhancing vascular tone, it improves circulation and helps maintain adequate blood flow when standing.
Is Midodrine effective?
Clinical studies have shown that Midodrine effectively increases blood pressure in patients with orthostatic hypotension, reducing symptoms like dizziness and fainting. Trials have demonstrated significant improvements in both standing and sitting blood pressure measurements. The medication has been proven to be more effective than a placebo in preventing blood pressure drops, improving quality of life for those with the condition.
What is Midodrine?
Midodrine is primarily used to treat orthostatic hypotension, a condition where blood pressure drops significantly upon standing. It works by stimulating alpha-1 receptors in blood vessels, causing them to constrict and raise blood pressure. This helps prevent symptoms like dizziness and fainting associated with low blood pressure. It is typically used when other treatments have been ineffective.
Directions for Use
For how long do I take Midodrine?
Midodrine is only worth taking if it makes you feel a lot better. Doctors don't say exactly how long you should take it for.
How do I dispose of Midodrine?
If you can, bring unused medicines to a drug take-back program or collection site at a pharmacy or hospital. They will dispose of this medicine properly so they don't harm people or the environment. If you can't find a take-back program, you can throw most medicines in the trash at home. But first, take them out of their original containers, mix them with something undesirable like used coffee grounds, seal the mixture in a plastic bag and throw it away.
How do I take Midodrine?
Midodrine can be taken with or without food, as food does not significantly affect its absorption. There are no specific food restrictions; however, it’s advised to avoid taking it close to bedtime to prevent sleep disturbances, as it may increase blood pressure while lying down. Always follow your healthcare provider's instructions for the correct timing and dosage.
How long does it take for Midodrine to start working?
Midodrine typically begins to work within 30 to 60 minutes after oral administration. Its effects can last for several hours, helping to raise blood pressure and alleviate symptoms like dizziness or fainting caused by orthostatic hypotension. The full benefit may be seen within a few days of consistent use, depending on individual response.
How should I store Midodrine?
Midodrine should be stored at room temperature, away from heat, moisture, and direct sunlight. Keep it in its original packaging to protect it from light and maintain its effectiveness. Ensure the medication is kept out of reach of children and pets. Do not use Midodrine after its expiration date and dispose of any unused medication properly.
What is the usual dose of Midodrine?
The typical adult dose of Midodrine is 10 milligrams, three times a day, but only during the daytime, about four hours apart. Higher doses are possible, but they increase the chance of high blood pressure when lying down. How to give it to children isn't known yet.
Warnings and Precautions
Can I take Midodrine with other prescription drugs?
Midodrine can interact with other blood pressure medications, such as beta-blockers, ACE inhibitors, and diuretics, potentially reducing its effectiveness or causing excessive blood pressure changes. It may also interact with monoamine oxidase inhibitors (MAOIs), leading to dangerous increases in blood pressure. Caution is needed when combining Midodrine with other medications that affect heart rate or blood pressure. Always consult a healthcare provider before combining medications.
Can Midodrine be taken safely while breastfeeding?
There is limited information on the safety of Midodrine during breastfeeding. It is not known whether the drug is excreted in breast milk, so caution is advised. Due to potential risks to the infant, it’s important for breastfeeding mothers to consult their healthcare provider to assess whether the benefits of taking Midodrine outweigh any potential risks to the baby.
Can Midodrine be taken safely while pregnant?
Midodrine is classified as a pregnancy Category C medication, meaning there is insufficient data on its safety during pregnancy. Animal studies have shown some potential risks, but no adequate human studies are available. It should only be used during pregnancy if the benefits outweigh the potential risks. Pregnant women should consult their healthcare provider before using Midodrine.
Does Midodrine have adverse effects?
Adverse effects, which are unwanted or harmful effects caused by a medicine, can vary in severity. For this medicine, common adverse effects might include nausea, headache, dizziness, fatigue, and dry mouth. These effects can occur in some people, but not everyone will experience them. Serious adverse effects, though rare, may include severe allergic reactions, chest pain, or difficulty breathing. These require immediate medical attention. It's important to report any new or worsening symptoms to a healthcare provider. Never stop taking a medicine without consulting a healthcare professional, as they can provide guidance on managing side effects or adjusting treatment.
Does Midodrine have any safety warnings?
This medicine, which is called atenolol, has several safety warnings. One major warning is that it should not be stopped suddenly, especially in patients with heart disease, because it can worsen the condition. The rationale is that sudden withdrawal can lead to increased heart rate and blood pressure, which may cause chest pain or even a heart attack. Symptoms to monitor include increased heart rate, chest pain, or shortness of breath. Another warning is that atenolol can mask the symptoms of low blood sugar, which is a condition where blood sugar levels drop too low. This is particularly important for people with diabetes. The consequence of not recognizing low blood sugar can be severe, leading to confusion or loss of consciousness. Signs to watch for include sweating, dizziness, or feeling unusually hungry. Lastly, atenolol may cause dizziness or fatigue, which can affect your ability to drive or operate machinery. It's important to be cautious and avoid these activities if you experience these symptoms.
Is it safe to drink alcohol while taking Midodrine?
It is not recommended to drink alcohol while taking Midodrine. Alcohol can lower blood pressure, which might counteract the effects of Midodrine and increase the risk of dizziness, fainting, or other complications. If you plan to drink alcohol, consult your doctor for guidance.
Is it safe to exercise while taking Midodrine?
Yes, it is generally safe to exercise while taking Midodrine. However, since Midodrine increases blood pressure, you should be cautious during physical activities, especially intense exercise, as it may elevate your blood pressure further.
Is it safe to stop Midodrine?
To determine if it's safe to stop a medicine, first identify its purpose. If it's for managing a chronic condition like hypertension or diabetes, stopping it might lead to worsening symptoms or complications. For medicines providing symptomatic relief, stopping might cause symptoms to return. If it's for a temporary condition like an infection, stopping early might not fully resolve the issue. Some medicines can cause withdrawal symptoms or rebound effects if stopped suddenly. In some cases, abrupt discontinuation can be life-threatening. Always consult a doctor before stopping any medicine to ensure it's safe and to discuss a proper plan for discontinuation if needed.
Is Midodrine addictive?
To determine if a medicine is addictive, we first need to know its name. If the medicine has habit-forming potential, it means it can cause dependence, which is when the body or mind feels a need for the drug. This can happen because the medicine changes how the brain works, making it hard to stop using it. Warning signs of addiction include needing more of the medicine to feel the same effects, using it more often than prescribed, or feeling anxious without it. To prevent addiction, follow the doctor's instructions, don't take more than prescribed, and talk to a healthcare provider if you feel you need the medicine more than before. If the medicine has no known potential for dependence or addiction, it means it is safe to use as directed without the risk of becoming addicted.
Is Midodrine safe for the elderly?
Midodrine raises blood pressure, and it works the same way in older and younger people, so you don't need a different dose based on age. However, it can cause very high blood pressure when lying down, especially if you take a lot. So, it's important to check your blood pressure regularly, both when lying down and sitting up. If your blood pressure gets too high while lying down, stop taking the medicine. Also, don't take it after 6 PM to avoid high blood pressure at night.
What are the most common side effects of Midodrine?
A side effect is an unwanted or unexpected symptom caused by a medicine. For this medicine, common side effects might include nausea, which is feeling sick to your stomach, dizziness, which is feeling lightheaded, headache, which is pain in your head, fatigue, which is feeling very tired, and dry mouth, which is when your mouth feels unusually dry. The frequency of these side effects can vary, but they are generally not experienced by everyone. It's important to remember that when starting a new medicine, you might notice new symptoms. These could be unrelated to the medicine, temporary, or due to another health issue. Always talk to your healthcare provider before stopping any medicine, as they can help you understand the risks and benefits.
Who should avoid taking Midodrine?
Midodrine should not be used in patients with high blood pressure, heart disease, or kidney problems, as it may exacerbate these conditions. It is contraindicated in those with urinary retention, pheochromocytoma, or thyroid disorders. Caution is needed in individuals with a history of stroke or arrhythmias. It’s important to monitor for supine hypertension, as it can lead to serious cardiovascular events.
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