Pharm

Midodrine

search

Midodrine, Proamatine

  • See Also
  1. Adrenergic Receptor
  2. Alpha Adrenergic Receptor
  3. Sympathetic Nervous System
  4. Sympathomimetic Toxicity
  5. Sympathomimetic
  • Indications
  1. Autonomic Neuropathy
  2. Recurrent Vasovagal Syncope
  3. Orthostatic Hypotension
  • Contraindications
  1. Severe cardiovascular disease
  2. Persistent supine Hypertension
  • Mechanism
  1. Alpha Agonist: constricts arterioles and veins
  2. Increases Peripheral Vascular Resistance
  • Medications
  1. Midodrine Tablets (scored): 2.5 mg, 5 mg and 10 mg
  • Dosing
  • Adults
  1. Avoid after 6 pm (in typical sleep schedules), to decrease risk of supine Hypertension while asleep
  2. Orthostatic Hypotension
    1. Start: 10 mg orally three times daily
    2. Maximum: 40 mg/day
  3. Renal Dosing
    1. Start: 2.5 mg orally three times daily
  • Adverse Effects
  1. Piloerection (goosebumps)
    1. Pilomotor reaction of Hair Follicles
  2. Paresthesias
  3. Pruritus
  4. Chills
  5. Urinary urgency, frequency and retention
  6. Supine Hypertension
    1. Risk of cardiovascular events (Acute Coronary Syndrome, Cerebrovascular Accident)
  • Safety
  1. Unknown safety in Lactation
  2. Pregnancy Category C (use only if benefit outweighs risk)
    1. Animal studies with decreased fetal survival and weight
  • Efficacy
  1. Neurogenic Orthostatic Hypotension
    1. Midodrine significantly improved standing BP and symptoms
    2. Low (1997) JAMA 277:1046-51 +PMID [PubMed]
  2. Recurrent Vasovagal Syncope
    1. Midodrine reduces recurrence rate by 30% (NNT 6) and event frequency in both adults and children
    2. Lei (2022) Europace 24(7):1171-8 +PMID: 35025999 [PubMed]
  • Drug Interactions
  1. MAO Inhibitors
  2. Linezolid
  3. Cardiac glycosides (e.g. Digoxin)
    1. Risk of Bradycardia and atrioventrioventricular block when combined with Midodrine
  4. Avoid in combination with Medication Causes of Hypertension
    1. See Medication Causes of Hypertension
  • Resources
  1. Midodrine (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=4c3517f3-1c68-4ade-b5f1-c488a3a335c1