Midodrine

Orthostatic hypotension

Oral Orthostatic hypotension Adult: Initially, 2.5 mg 2-3 times daily, adjusted gradually according to response at weekly intervals, up to 10 mg tid. Last dose of the day should not be taken after evening meal or <4 hr before bedtime to reduce potential for supine HTN. Renal impairment: Initially, 2.5 mg 2-3 times daily, gradually increased as tolerated.

Severe organic heart disease (e.g. bradycardia, ischaemic heart disease, CHF), acute renal failure, urinary retention, phaeochromocytoma, thyrotoxicosis, persistent and excessive supine HTN.

Patient w/ DM, history of visual problems (esp when taken w/ fludrocortisone). Hepatic and renal impairment. Pregnancy and lactation. Monitoring Parameters Monitor supine and sitting BP; hepatic and renal function.

C Pregnancy category: C Lactation: Not known if excreted into breast milk; avoid

Enhanced pressor effects w/ α-adrenergic agonists (e.g. phenylephrine, ephedrine, dihydroergotamine, phenylpropanolamine, pseudoephedrine). Reduced effect w/ α-adrenergic blockers (e.g. prazosin, terazosin, doxazosin). May precipitate bradycardia, AV block, or arrhythmia w/ cardiac glycosides.

>10% Paresthesia (18%) Piloerection (13%) Pruritus (13%) Supine hypertension (7-13%) Urinary retention or urgency (up to 13%) 1-10% 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

Midodrine, a direct-acting sympathomimetic amine, is a prodrug which forms an active metabolite, desglymidodrine. It selectively activates the α1-adrenergic receptors of the arteriolar and venous vasculature, producing peripheral vasoconstriction and elevation of BP.