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Generic Name: midodrine
Brand Names: Orvaten, ProAmatine (discontinued brand)
Drug Class: Alpha1 Agonists
What is midodrine, and what is it used for?
Midodrine is a medication used to treat orthostatic hypotension, also known as postural hypotension, a condition that causes a drop in blood pressure when standing up from sitting or lying down. The sudden drop in blood pressure can cause dizziness, lightheadedness, and fainting. Midodrine prevents the rapid drop in blood pressure.
Midodrine belongs to a class of medications known as alpha1 agonists. Midodrine binds to alpha1 adrenergic receptors and stimulates their activity. Alpha1 adrenergic receptors are protein molecules located in many smooth muscle tissues, including blood vessels, heart muscle, hair follicles and bladder neck.
When alpha1 receptors are stimulated, they make these smooth muscles contract. The contraction of vascular muscle constricts the blood vessels, increasing vascular resistance to blood flow, which results in a rise in blood pressure.
Midodrine is also used off-label for treating urinary continence caused by activities such as coughing, sneezing, laughing, running or lifting heavy weights, which put pressure on the bladder. Midodrine prevents urine leakage by making the bladder neck muscles contract. Midodrine’s effects on the hair follicles cause side effects such as goosebumps and itching.
Warnings
- Do not use midodrine in the following conditions:
- Severe organic heart disease
- Acute kidney disease
- Urinary retention
- Pheochromocytoma, a type of tumor on the adrenal gland
- Excessive thyroid hormones in the blood (thyrotoxicosis)
- Midodrine can significantly elevate blood pressure even while lying down (supine hypertension). Monitor supine and sitting blood pressure and discontinue if there is excessive or persistent supine hypertension.
- Avoid simultaneous use of drugs that increase blood pressure. If concomitant use cannot be avoided, monitor blood pressure closely.
- Midodrine may slow heart rate (bradycardia). Use with caution if administered concurrently with medications that slow down heart rate, monitor the patient and discontinue midodrine if symptoms of bradycardia develop.
- Use with caution in patients with urinary retention problems, midodrine can exacerbate the condition.
- Avoid concomitant administration with monoamine oxidase inhibitors (MAOI) antidepressant medications or linezolid, an antibacterial agent. These drugs can increase the effect of midodrine and lead to acute hypertensive episode.
- Avoid concurrent use with other drugs that can cause vasoconstriction.
- Use with caution in patients with kidney or liver impairment, diabetes or vision problems.
What are the side effects of midodrine?
Common side effects of midodrine include:
- Abnormal skin sensations (paresthesia) including in the scalp
- Goosebumps (piloerection)
- Painful urination (dysuria)
- Increased urinary frequency and urgency
- Impaired urination
- Urinary retention
- Itching (pruritus) including in the scalp
- Supine hypertension
- Increase in systolic blood pressure
- Chills
- Abdominal or other pain
- Skin rash
Less common side effects of midodrine include:
- Headache
- Feeling of pressure or fullness in the head
- Vasodilation
- Facial flushing
- Dry mouth
- Nervousness
- Anxiety
- Confusion
- Thinking abnormality
Rare side effects of midodrine include:
- Visual field defect
- Altered sense of smell
- Taste perversion (dysgeusia)
- Dizziness
- Heightened skin sensitivity (hyperesthesia)
- Insomnia
- Drowsiness (somnolence)
- Severe skin reactions including:
- Erythema multiforme
- Acute generalized exanthematous pustulosis (AGEP)
- Canker sore
- Dry skin
- Weakness (asthenia)
- Backache
- Leg cramps
- Heartburn (pyrosis)
- Nausea
- Gastrointestinal distress
- Gas (flatulence)
- Slow heart rate (bradycardia)
This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug.
Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.
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What are the dosages of midodrine?
Tablet
- 2.5 mg
- 5 mg
- 10 mg
Adult:
Symptomatic Orthostatic Hypotension
- 2.5-10 mg orally every 8 hours
- Usual dose: 10 mg orally every 8 hours
- Doses greater than 30 mg/day have not been studied; should not exceed 40 mg/day
Stress Incontinence (Off-label)
- 2.5-5 mg orally every 8-12 hours
Dosing Modifications
- Renal impairment: 2.5 mg orally every 8 hours; increase as tolerated
Pediatric:
- Safety and efficacy not established
Overdose
- Midodrine overdose causes symptoms that include high blood pressure (hypertension), goosebumps (piloerection), a sensation of coldness and urinary retention.
- Overdose is treated with induced vomiting and gastric lavage to eliminate undigested drug in the gastrointestinal tract, and administration of antihypertensive alpha1 blockers such as phentolamine to reduce the blood pressure.
What drugs interact with midodrine?
Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.
- Severe interactions of midodrine include:
- isocarboxazid
- linezolid
- phenelzine
- selegiline transdermal
- tranylcypromine
- Midodrine has serious interactions with at least 32 different drugs.
- Midodrine has moderate interactions with at least 180 different drugs.
- Mild interactions of midodrine include:
- desmopressin
- eucalyptus
- hydrochlorothiazide
- memantine
- metformin
- methyclothiazide
- ofloxacin
- quinine
- sage
- sulfamethoxazole
- triamterene
- trimethoprim
- verapamil
The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.
It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information.
Check with your doctor or health care provider if you have any questions about the medication.
Pregnancy and breastfeeding
- There are no adequate and well-controlled studies of midodrine use in pregnant women, and animal reproductive studies show evidence of fetal harm. Use midodrine during pregnancy with caution, and only if potential benefits to the mother justify potential risks to the fetus.
- It is not known if midodrine is excreted in breast milk. Use with caution in nursing mothers because many drugs are present in breast milk.
What else should I know about midodrine?
- Take midodrine exactly as prescribed. Take no later than 6 pm and 3 to 4 hours before bed to minimize the risk for nighttime supine hypertension. If you experience symptoms such as pounding in the ears, headache or blurred vision, discontinue the medication and report to your physician.
- If you experience slow pulse, dizziness or fainting, discontinue midodrine and consult with your physician.
- Some over-the-counter (OTC) medications such as cold remedies or diet aids can increase blood pressure. Check with your physician before taking any OTC drugs while on midodrine therapy.
- Store midodrine carefully out of reach of children.
- In case of overdose, immediately seek medical help or contact Poison Control.
