Midodrine
Orthostatic Hypotension, Urinary Incontinence
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DRUG STATUS
Approvals
US(FDA), UK(BNF)
Essential Medicine
NO
Teratogenicity
Unlisted
Pharmaceutical Class
Alpha-Adrenergic Agonist
Midodrine
Know More About This Medicine -
Click HereSummary
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
What is Midodrine used for?
Midodrine is primarily indicated for the treatment of orthostatic hypotension, a condition characterized by a significant drop in blood pressure when standing, leading to dizziness or fainting. It is also used off-label for other conditions that involve low blood pressure, such as certain types of hypotension related to autonomic dysfunction or severe kidney disease.
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.
How does one know if Midodrine is working?
The benefit of Midodrine is evaluated by monitoring blood pressure levels, particularly the standing blood pressure, to assess its ability to prevent orthostatic hypotension symptoms like dizziness and fainting. Healthcare providers may track improvements in symptoms through patient reports and regular blood pressure checks. Adjustments in dosage may be made based on these evaluations.
Directions for Use
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.
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.
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 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.
Warnings and Precautions
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.
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 I take Midodrine with vitamins or supplements?
There are no major known interactions between Midodrine and vitamins or supplements. However, it's important to be cautious with supplements that affect blood pressure, such as potassium or magnesium, as they may influence Midodrine’s effectiveness. Always consult a healthcare provider before using any supplements, especially if taking other medications that impact blood pressure.
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.
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.
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.
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 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.
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