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 |
Ontology: Midodrine (C0026078)
| Definition (MSH) | An ethanolamine derivative that is an adrenergic alpha-1 agonist. It is used as a vasoconstrictor agent in the treatment of HYPOTENSION. |
| Definition (NCI) | A direct-acting prodrug and sympathomimetic agent with antihypotensive properties. Midodrine is converted to its active metabolite, desglymidodrine by deglycination reaction. Desglymidodrine selectively binds to and activates alpha-1-adrenergic receptors of the arteriolar and venous vasculature. This causes smooth muscle contraction and leads to an elevation of blood pressure. Desglymidodrine diffuses poorly across the blood-brain barrier, and is therefore not associated with effects on the central nervous system (CNS). |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D008879 |
| SnomedCT | 108539003, 372504000 |
| English | Midodrin, Midodrine, Acetamide, 2-amino-N-(2-(2,5-dimethoxyphenyl)-2-hydroxyethyl)-, Midodrine [Chemical/Ingredient], midodrin, midodrine, MIDODRINE, Midodrine (product), Midodrine (substance) |
| Swedish | Midodrin |
| Czech | midodrin |
| Finnish | Midodriini |
| Russian | MIDODRIN, МИДОДРИН |
| Japanese | ミドドリン |
| Polish | Midodrin |
| Spanish | midodrina (producto), midodrina (sustancia), midodrina, Midodrina |
| French | Midodrine |
| German | Midrodin |
| Italian | Midodrina |
| Portuguese | Midodrina |
