midodrine

REMS

Symptomatic management of refractory orthostatic hypotension in patients whose lives are impaired.

Action ⬆ ⬇

Activation of alpha-1-adrenergic receptors in arteries and veins.

Therapeutic effects:

Increase in vascular tone and BP.

Pharmacokinetics ⬆ ⬇

Absorption: 93% absorbed following oral administration; rapidly converted to desglymidodrine, the active metabolite.

Distribution: Desglymidodrine crosses the blood-brain barrier poorly.

Metabolism/Excretion: Desglymidodrine is 80% excreted by the kidneys.

Half-Life: Midodrine: 25 min; desglymidodrine: 3–4 hr.

Time/Action Profile ⬆ ⬇

(blood levels of active metabolite)

ROUTE	ONSET	PEAK	DURATION
PO	rapid	1–2 hr	2–3 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Urinary retention;
Severe organic heart disease;
Acute renal disease;
Persistent/excessive supine hypertension;
Pheochromocytoma;
Thyrotoxicosis.

Use Cautiously in:

History of hypertension;
Renal impairment (↓ initial dose);
Hepatic impairment;
Diabetes mellitus, visual problems, concurrent fludrocortisone (↑ risk of visual disturbances);
OB: Safety not established in pregnancy;
Lactation: Safety not established in breastfeeding;
Pedi: Safety and effectiveness not established in children.

Adv. Reactions/Side Effects ⬆ ⬇

CV: supine hypertension, bradycardia

Derm: piloerection, pruritus, facial flushing, rash

GU: dysuria, urinary urge/retention/frequency

Neuro: paresthesia, anxiety, confusion, head pressure/fullness, headache, nervousness

Misc: chills, pain

Interactions ⬆ ⬇

Drug-drug:

↑risk of bradycardia with digoxin, beta blockers, and antipsychotics.
Phenylephrine, ephedrine, pseudoephedrine, thyroid hormones, droxidopa, dihydroergotamine, MAO inhibitors, or linezolid may significantly ↑ BP; avoid concurrent use.
Alpha-adrenergic blockers, including prazosin, terazosin, and doxazosin, may ↓ effectiveness.
May ↑ effects of fludrocortisone; ↓ initial dose of fludrocortisone or ↓ salt intake prior to midodrine.

Route/Dosage ⬆ ⬇

PO (Adults ): 10 mg three times daily.

Renal Impairment

PO (Adults ): 2.5 mg three times daily.

Availability ⬆ ⬇

(Generic available)

Tablets: 2.5 mg; 5 mg ; 10 mg

Assessment ⬆ ⬇

Monitor supine and sitting BP prior to and during therapy.

Lab Test Considerations:

Monitor renal and hepatic function prior to and periodically during therapy.

Implementation ⬆ ⬇

Because midodrine can cause marked ↑ of supine BP, it should be used in patients whose lives are considerably impaired despite standard clinical care.
PO: Administer three times daily at 3–4 hr intervals. Do not administer after last meal or within 4 hr of bedtime.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take midodrine as directed. 1st dose should be taken on or shortly after arising, 2nd dose at midday, and 3rd dose should be taken before evening meal and ≥4 hr before bedtime. Take missed doses as soon as remembered unless almost time for next dose; do not double doses.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care provider before taking other medications.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇