II. Indications
III. Contraindications
- Severe cardiovascular disease
- Persistent supine Hypertension
IV. Mechanism
- Alpha Agonist: constricts arterioles and veins
- Increases Peripheral Vascular Resistance
V. Medications
- Midodrine Tablets (scored): 2.5 mg, 5 mg and 10 mg
VI. Dosing: Adults
- Avoid after 6 pm (in typical sleep schedules), to decrease risk of supine Hypertension while asleep
-
Orthostatic Hypotension
- Start: 10 mg orally three times daily
- Maximum: 40 mg/day
-
Renal Dosing
- Start: 2.5 mg orally three times daily
VII. Adverse Effects
- Piloerection (goosebumps)
- Pilomotor reaction of Hair Follicles
- Paresthesias
- Pruritus
- Chills
- Urinary urgency, frequency and retention
- Supine Hypertension
- Risk of cardiovascular events (Acute Coronary Syndrome, Cerebrovascular Accident)
VIII. Safety
- Unknown safety in Lactation
- Pregnancy Category C (use only if benefit outweighs risk)
- Animal studies with decreased fetal survival and weight
IX. Efficacy
- Neurogenic Orthostatic Hypotension
- Midodrine significantly improved standing BP and symptoms
- Low (1997) JAMA 277:1046-51 +PMID [PubMed]
- Recurrent Vasovagal Syncope
- Midodrine reduces recurrence rate by 30% (NNT 6) and event frequency in both adults and children
- Lei (2022) Europace 24(7):1171-8 +PMID: 35025999 [PubMed]
X. Drug Interactions
- MAO Inhibitors
- Linezolid
- Cardiac glycosides (e.g. Digoxin)
- Risk of Bradycardia and atrioventrioventricular block when combined with Midodrine
- Avoid in combination with Medication Causes of Hypertension
XI. Resources
Images: Related links to external sites (from Bing)
Related Studies
| midodrine (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| MIDODRINE HCL 10 MG TABLET | Generic | $0.36 each |
| MIDODRINE HCL 2.5 MG TABLET | Generic | $0.19 each |
| MIDODRINE HCL 5 MG TABLET | Generic | $0.22 each |