Blood Pressure Uses, Warnings, Side Effects, Dosage


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.

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:

Rare side effects of midodrine include:

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

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:

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.

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Medically Reviewed on 6/6/2022

References


https://www.rxlist.com/consumer_midodrine_proamatine/drugs-condition.htm

https://reference.medscape.com/drug/proamatine-orvaten-midodrine-342442#0

https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/019815s010lbl.pdf

https://www.uptodate.com/contents/midodrine-drug-information



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