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midodrine (Oral route)

Pronunciation

MYE-doe-dreen

Oral route(Tablet)

Can cause marked elevation of supine blood pressure and should be used only in patients whose lives are considerably impaired despite standard clinical care .

Commonly used brand name(s)

In the U.S.

  • Orvaten
  • Proamatine

Available Dosage Forms:

  • Tablet

Therapeutic Class: Vasopressor

Pharmacologic Class: Alpha-Adrenergic Agonist

Uses For midodrine

Midodrine is used to treat low blood pressure (hypotension). It works by stimulating nerve endings in blood vessels, causing the blood vessels to tighten. As a result, blood pressure is increased.

midodrine is available only with your doctor's prescription.

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Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although not specifically included in product labeling, midodrine is used in certain patients with the following medical conditions:

  • Low blood pressure (hypotension) caused by kidney dialysis.
  • Low blood pressure caused by certain medicines used to treat mental illness.
  • Low blood pressure in children with an infection.

Before Using midodrine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For midodrine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to midodrine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

midodrine has been tested in a limited number of children 6 months to 12 years of age. In effective doses, the medicine has not been shown to cause different side effects or problems than it does in adults.

Geriatric

midodrine has been tested and has not been shown to cause different side effects or problems in older people than it dose in younger adults.

Pregnancy

Pregnancy Category Explanation
All Trimesters C Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking midodrine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using midodrine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Dihydroergotamine

Using midodrine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Amitriptyline
  • Amoxapine
  • Clomipramine
  • Desipramine
  • Deslanoside
  • Digitoxin
  • Dothiepin
  • Doxepin
  • Ephedrine
  • Imipramine
  • Iobenguane I 123
  • Lofepramine
  • Nortriptyline
  • Opipramol
  • Phenylephrine
  • Phenylpropanolamine
  • Protriptyline
  • Pseudoephedrine
  • Trimipramine

Using midodrine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Perphenazine
  • Promethazine
  • Risperidone

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of midodrine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Heart disease, severe or
  • Hypertension (high blood pressure) or
  • Overactive thyroid or
  • Visual problems—Effects of midodrine on blood pressure may aggravate these problems.
  • Kidney disease or
  • Liver disease—The effects of midodrine may be increased because of slower removal of the medicine from the body.
  • Urinary retention—Effects of midodrine on the bladder may aggravate this condition.

Proper Use of midodrine

The last dose of midodrine should not be taken after the evening meal or less than 3 to 4 hours before bedtime because high blood pressure upon lying down (supine hypertension) can occur, which can cause blurred vision, headaches, and pounding in the ears while lying down after taking midodrine.

Also, midodrine should not be taken if you will be lying down for any length of time.

Dosing

The dose of midodrine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of midodrine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (tablets):
    • For low blood pressure:
      • Adults—10 milligrams (mg) three times a day in approximately 4-hour intervals during daytime hours: shortly before or upon rising in the morning, at midday, and in the late afternoon (not later than 6 p.m.). Your doctor may increase your dose if needed.
      • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of midodrine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using midodrine

Do not take other medicines unless they have been discussed with your doctor. This especially includes over-the-counter (nonprescription) medicines for appetite control, asthma, colds, cough, hayfever, or sinus problems, since they may tend to increase your blood pressure.

midodrine Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common
  • Blurred vision
  • cardiac awareness
  • headache
  • pounding in the ears
Rare
  • Fainting
  • increased dizziness
  • slow pulse

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Burning, itching, or prickling of the scalp
  • chills
  • goosebumps
  • urinary frequency, retention, or urgency
Less common
  • Anxiety or nervousness
  • confusion
  • dry mouth
  • flushing
  • headache or feeling of pressure in the head
  • skin rash
Rare
  • Backache
  • canker sores
  • dizziness
  • drowsiness
  • dry skin
  • leg cramps
  • pain or sensitivity of the skin to touch
  • stomach problems such as gas, heartburn, or nausea
  • trouble seeing
  • trouble with sleeping
  • weakness

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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