From the Guidelines
The recommended dosage of midodrine (ProAmatine) for treating orthostatic hypotension is up to two to four times 10 mg/day, with the first dose taken before arising and use avoided several hours before planned recumbency, particularly in patients with documented supine hypertension. This dosing regimen is individually tailored to minimize postural symptoms rather than to restore normotension, as stated in the study by 1. The goal of treatment is to balance the increase in standing blood pressure with the avoidance of marked supine hypertension.
Key considerations for midodrine dosing include:
- The first dose should be taken before arising to help manage morning orthostatic hypotension
- Avoiding use several hours before planned recumbency to prevent supine hypertension
- Individualizing the dose based on patient response and tolerability
- Monitoring blood pressure response, particularly when initiating therapy or adjusting doses
Common adverse events associated with midodrine include pilomotor reactions, pruritus, supine hypertension, bradycardia, gastrointestinal symptoms, and urinary retention, as noted in the study by 1. Midodrine is the only medication approved by the Food and Drug Administration for the treatment of symptomatic orthostatic hypotension, making it a first-line treatment option for this condition.
From the FDA Drug Label
The recommended dose of midodrine hydrochloride tablets is 10 mg, 3 times daily. Dosing should take place during the daytime hours when the patient needs to be upright, pursuing the activities of daily living A suggested dosing schedule of approximately 4-hour intervals is as follows: shortly before, or upon arising in the morning, midday and late afternoon (not later than 6 P.M.) The recommended dosage of midodrine (ProAmatine) for treating orthostatic hypotension is 10 mg, 3 times daily. The dosing frequency should be approximately 4-hour intervals, with the last dose not later than 6 P.M. to reduce the potential for supine hypertension during sleep 2.
- Key points:
- Dose: 10 mg
- Frequency: 3 times daily
- Last dose: not later than 6 P.M.
- Interval: approximately 4-hour intervals
From the Research
Midodrine Dosage and Frequency
- The recommended dosage of midodrine for treating orthostatic hypotension is typically 2.5 to 10 mg, taken two to three times daily 3.
- A study found that a 10-mg dose of midodrine, prescribed two to three times daily, is effective in increasing orthostatic blood pressure and ameliorating symptoms in patients with neurogenic orthostatic hypotension 3.
- The half-life of desglymidodrine, the active metabolite of midodrine, is approximately 4 hours, which supports the recommended dosing frequency 3.
- It is essential to take the final daily dose of midodrine at least 4 hours before bedtime to reduce the risk of supine hypertension, which can occur in up to 25% of patients 4.
Administration and Efficacy
- Midodrine is almost completely absorbed after oral administration and undergoes enzymatic hydrolysis to form its pharmacologically active metabolite, desglymidodrine 5.
- Midodrine significantly increases standing systolic blood pressure and improves symptoms of orthostatic hypotension, such as dizziness, light-headedness, and syncope 4, 5, 3.
- Comparative studies have shown midodrine to be clinically at least as effective as other sympathomimetic agents and dihydroergotamine in the management of orthostatic hypotension 4, 5.