Midodrine - Oral

What Is Midodrine?

Midodrine is an orally administered prescription oral medication used to treat orthostatic hypotension, or the sudden fall of blood pressure when standing after sitting or lying down. Orthostatic refers to an upright posture, also known as postural hypotension.

Midodrine is classified as a sympathomimetic (an alpha-1 adrenergic agonist) and is approved for adults 18 and older. 

Alpha-adrenergic agonists are medications used to treat hypertension among other cardiovascular issues, such as septic shock, hypotension, and cardiopulmonary (sudden loss of heart function) arrest.

Midodrine comes in 2.5 milligrams, 5 milligrams, and 10 milligrams doses.

Midodrine works by activating the nerve endings in blood vessels to tighten, which increases blood pressure.

No current brand-name version of midodrine exists. However, midodrine exists as a generic product available in the form of an oral (taken by mouth) tablet.

What Is Midodrine Used For?

The Food and Drug Administration (FDA) has approved midodrine as an oral therapy to treat orthostatic hypotension in adults.

Orthostatic hypotension is a condition that causes a drop in blood pressure when moving from a lying or sitting position to a standing position. This drop in blood pressure can cause dizziness and even fainting.

In people with orthostatic hypotension, hypoperfusion (reduced blood flow) to other organs can lead to an increased chance of serious health issues, such as heart attack, atrial fibrillation (AFib; heart rhythm abnormalities), stroke, or chronic kidney disease (CKD).

How to Take Midodrine

Midodrine must be taken by mouth, with a standard dose being taken three times a day during daytime hours. The doses need to be taken at least three hours apart and can be taken in the morning, afternoon, and late afternoon (before 6 p.m.).

The last dose should be taken before the evening meal and at least four hours before bedtime. Use it during daytime hours when you need to be active and standing. Don't take a dose if you will be lying down for any length of time.

This medication can be taken with or without food. It is recommended not to lie down after taking this drug as it can increase your blood pressure. Finally, take midodrine at the same times every day.

Storage

Keep midodrine stored at room temperature (68 F to 77 F) in a safe, dry location.

Also, keep out of reach of children and pets. Be sure to throw away unused or expired drugs, but do not flush them down a toilet or pour them down a drain unless you are told to do so by a healthcare provider.

It is recommended that you discuss with your healthcare provider if you have questions about the best way to throw away expired/unwanted drugs. Keep in a dry place away from light and out of reach of children and pets.

Off-Label Uses

Midodrine can be used as an off-label medication in people with heart failure with reduced ejection fraction (a type of heart failure that causes less oxygen-rich blood to reach the rest of your body from the heart than normal).

Also, midodrine can be used in the treatment of intradialytic hypotension (IDH; low blood pressure as a result of dialysis).

What Are the Side Effects of Midodrine?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

Common side effects of midodrine may include:

• Dry, itchy scalp
• Numbness and tingling
• Fever and chills 
• Frequent urination
• Urticaria (hives)
• Stomach Pain

Severe Side Effects

Call your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you have a medical emergency.

Serious side effects and their symptoms can include the following:

• Bradycardia (a slow heartbeat)
• Dizziness
• Fainting
• Extreme high blood pressure (especially when lying down)
  

Long-Term Side Effects

The long-term side effects associated with the use of midodrine include: 

• Dizziness
• Headache
• Anxiety or nervousness

Dosage: How Much Midodrine Should I Take?

Modifications

In some cases, your healthcare provider may need to adjust the use of your treatment or dosage:

Pregnancy: There are no adequate studies on pregnant people. Midodrine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Breastfeeding: It is not known whether this drug is expelled through human milk. Because drugs are commonly expelled through human milk, caution should be used when midodrine is given to a nursing person.

Children: Midodrine is not recommended for people under 18 since it has not been adequately studied in this age group.

Kidney issues: If you have kidney problems, your healthcare provider may be cautious and start you on a lower dose, such as 2.5 milligrams.

Missed Dose

Take the missed dose as soon as you remember it. If it is almost time for the next dose, skip the missed dose and continue your regular schedule.

Do not take a double dose to make up for missed doses, as this may lead to an overdose. The last dose should be four hours before your bedtime and preferably before the evening meal.

Overdose: What Happens If I Take Too Much Midodrine?

If you take too much midodrine, you may experience hypertension, bradycardia, fatigue, and headache.

Overdosing on midodrine is rare, but if you or someone else has taken more than the recommended dose of midodrine and is experiencing side effects, it is best to call the Poison Control Center to ask for guidance or to go to a local emergency room for evaluation.

Precautions

What Are Reasons I Shouldn’t Take Midodrine?

You should avoid midodrine if you have heart disease, kidney disease, urinary retention (trouble emptying your bladder completely), pheochromocytoma (a type of tumor), or thyrotoxicosis (excessive thyroid hormone).

Your healthcare provider will help you determine if midodrine is the right medication for you.

What Other Medications Interact With Midodrine?

Midodrine may interact with other drugs. Before starting treatment, tell your healthcare provider about all your medications, including prescription or over-the-counter (OTC) medications, vitamins, and herbal products.

Please inform your healthcare provider if you are taking any of the drugs below as they can interact with midodrine as most of them increase the risk of high blood pressure:

• Avoid medications that increase the risk of blood pressure, such as Biorphen (phenylephrine) or Sudafed 12 Hour (pseudoephedrine).
• Cardiac glycosides, such as digoxin, can increase the risk of having a low heart rate, or arrhythmia.
• Dihydroergotamine (DHE): Avoid taking this medication with midodrine, which causes the risk of chest pain, hypertension, and tachycardia (fast heart rate).
• Medications used for depression, such as Marplan (isocarboxazid), Nardil (phenelzine), or Parnate (tranylcypromine)
• Drugs used for Parkinson's disease, such as Emsam (selegiline) or Azilect (rasagiline)
• The antibiotic drug, Zyvox (linezolid)
  

What Medications Are Similar?

Other medications may be used to treat orthostatic hypotension, including but not limited to:

• Vazculep (phenylephrine hydrochloride injection): Similar to midodrine, Vazculep belongs to the alpha-1 agonist class of drugs. It treats hypotension episodes from anesthesia.
• Northera (droxidopa): Used to treat dizziness, lightheadedness, and orthostatic hypotension caused by Parkinson's disease.
• Regonol (pyridostigmine): Unlike midodrine, Regnonol is an injection; however, it can be used for orthostatic hypotension.
  

How Can I Stay Healthy While Taking Midodrine?

To stay healthy while taking midodrine, it is important to take it as directed by your healthcare provider.

It may be difficult to initially take it consistently, but to treat your symptoms effectively; it must be taken as prescribed. It is recommended to use a tool to remind you when taking this medication.

It is important to follow up with your healthcare provider for recommended visits and inform them of any other drugs you plan to take as they may interact with the medication.

In addition, please monitor your blood pressure at home, and report side effects to your healthcare provider.