An Overview of Midodrine

A Drug for Orthostatic Hypertension

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Midodrine is a medication used to treat a condition known as orthostatic hypotension. The word "orthostatic" refers to being in an upright position, and "hypotension" refers to unusually low blood pressure (BP). In other words, when you have orthostatic hypotension, your blood pressure drops as you move into an upright position.

A healthcare provider may diagnose you with orthostatic hypotension if your blood pressure's systolic number (the top number) falls more than 20 mm Hg (millimeters of mercury), or if the diastolic number (the bottom number) drops more than 10 mm Hg. This medication is also known by the following two brand names: Orvaten and Proamatine.

Side effects of Midodrine
Illustration by JR Bee, Verywell.

Uses

Midodrine belongs to a class of medications called alpha-adrenergic agonists. The way these medications work is by stimulating the blood vessels to tighten, which increases your blood pressure. Midodrine comes in tablet form and is only available with a prescription.

Your doctor may provide you with a prescription for midodrine if you have significantly low blood pressure that impedes your ability to function on a daily basis. Your healthcare provider will need to consider the degree in which your condition impacts your life when choosing a medication for you.

Symptoms of midodrine that could interfere with your daily life include severe dizziness, light-headedness when you’re standing, and the sensation that you’re going to pass out—also known as syncope.

A study in the British Journal of Cardiology showed that midodrine can be helpful for a specific kind of syncope know as reflex syncope, where there is a short-term loss of consciousness due to a neural reflex, which results in lower blood pressure.

Administration

Often, midodrine is taken three times per day—typically in the morning, middle of the afternoon, and before dinner. Your doctor may ask you to consistently space your medication doses out during the day and end at a certain time before you go to bed.

Like most prescriptions, you’ll need to take your medication in the manner that your doctor ordered, and you’ll want to take it around the same time each day.

Since the goal of drug therapy is to decrease symptoms of low blood pressure when you are upright, you’ll want to avoid taking the medication at night.

If you need to lie down for a significant amount of time, you may receive specialized instructions as to how to position yourself in bed. One way may be to elevate your head whenever you take a nap or sleep at night.   

If you miss a dose of the drug, take it as soon as possible, provided that it’s within the timeframe that the doctor specified. However, if it’s close to the time you’re supposed to take your next dose, skip the dose that you missed and begin your normal medication schedule again. Try not to take a greater or lesser amount of the medication than your doctor recommended.

Side Effects

With any medication, side effects may occur. They can vary in intensity from mild to more severe. Occasionally, some of the undesirable effects can subside as your body adjusts to the medication. However, if symptoms persist, worsen, or are difficult to tolerate, consult with your doctor as soon as possible. The side effects most likely to occur when taking this medication include:

Common Side Effects of Midodrine

  • Itchy scalp
  • Numbness and tingling sensations
  • Chills, shivering, or feeling cold
  • Presence of goosebumps
  • Changes in urinary habits like frequency, urgency, or retention
  • Feeling nervous or anxious

While there’s potential for the following side effects, they are less likely to occur. These include rashes on the skin, headaches, nausea or abdominal pain, dry mouth, difficulty sleeping, and cramping of the leg muscles.

Some side effects associated with taking midodrine can be serious, and you should speak with your doctor immediately if you experience any of them. They are as follows:

  • slow heartbeat.
  • fainting.
  • feeling dizzy.
  • episodes of confusion.
  • changes in vision.
  • an unusual feeling in your chest.

Bear in mind that this is not a complete guide to the side effects, so you may experience symptoms that aren’t on this list. If you notice undesirable effects upon starting this medication, alert your healthcare provider.

Precautions

If you’ve had an allergic reaction to midodrine or the ingredients contained in it, you’ll want to avoid this medication and talk to your doctor about other options. If you want a list of ingredients in the drug, you can get one from your pharmacist.

Additionally, notify your doctor if you’re taking other medications, whether prescription or over-the-counter, herbs, or supplements. Certain drugs may increase your blood pressure. Some of those medications include, but aren’t limited to digoxin, fludrocortisone, certain antidepressants, asthma medications, and thyroid medications

You may not be able to take this medication if you’re taking other prescriptions that lower your blood pressure.

If you would like more information regarding midodrine and the use of other drugs, talk to your pharmacist or physician. 

A Word From Verywell

If there is something that you don’t understand regarding the use of midodrine or any drug, please ask your doctor or pharmacist for clarification to avoid any confusion. As always, take your medication as prescribed by your health care provider and keep your appointments for any lab work your doctor may order to monitor your body’s response to the drug.

If the medication doesn’t feel like it’s helping you manage your condition, your condition worsens, or you experience undesirable side effects, quickly let your doctor know what's going on—she may need to re-evaluate and consider other treatment options.

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Article Sources
  • Anwar AS, Saeed Y, Zaki Y, et al. Midodrine is safe and effective in the treatment of reflex syncope. British Journal of Cardiology. June 2016; 23:73–7. DOI: 10.5837/bjc.2016.021

  • Merck Manual. Orthostatic Hypotension.

  • Medline Plus. Midodrine.

  • Smith W, Wan H, Much D, Robinson AG, Martin P. Clinical benefit of midodrine hydrochloride in symptomatic orthostatic hypotension: a phase 4, double-blind, placebo-controlled, randomized, tilt-table study. Clinical Autonomic Research. 2016; 26: 269–277. doi: 10.1007/s10286-016-0363-9