What are the indications and contraindications for midodrine?

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Last updated: June 5, 2025 • View editorial policy

From the Guidelines

Midodrine is indicated for the treatment of orthostatic hypotension in patients with neurogenic orthostatic hypotension, particularly when other measures have failed, as stated in the 2017 ACC/AHA/HRS guideline 1. The primary use of midodrine is to improve symptoms of orthostatic hypotension in patients with neurogenic orthostatic hypotension.

  • Indications for midodrine include: + Neurogenic orthostatic hypotension + Symptomatic orthostatic hypotension
  • Contraindications for midodrine include: + Severe organic heart disease + Acute renal disease + Urinary retention + Pheochromocytoma + Thyrotoxicosis + Persistent and excessive supine hypertension + Known hypersensitivity to the drug The dosing regimen for midodrine is typically 2.5-10 mg three times daily, with the last dose taken at least 4 hours before bedtime to avoid supine hypertension, as recommended in the 2011 study on cardiovascular autonomic neuropathy in diabetes 2.
  • Common side effects of midodrine include: + Piloerection (goosebumps) + Paresthesia + Pruritus + Supine hypertension + Urinary urgency or retention + Headache It is essential to monitor blood pressure during treatment with midodrine, particularly when initiating therapy or adjusting doses, to prevent dangerous elevations in supine blood pressure, as noted in the 2017 ACC/AHA/HRS guideline 1.

From the FDA Drug Label

INDICATIONS AND USAGE Midodrine hydrochloride tablets are indicated for the treatment of symptomatic orthostatic hypotension (OH) CONTRAINDICATIONS Midodrine hydrochloride tablets are contraindicated in patients with severe organic heart disease, acute renal disease, urinary retention, pheochromocytoma or thyrotoxicosis. Midodrine should not be used in patients with persistent and excessive supine hypertension.

The indications for midodrine are:

  • Treatment of symptomatic orthostatic hypotension (OH) 3 The contraindications for midodrine are:
  • Severe organic heart disease
  • Acute renal disease
  • Urinary retention
  • Pheochromocytoma
  • Thyrotoxicosis
  • Persistent and excessive supine hypertension 4

From the Research

Indications for Midodrine

  • Midodrine is indicated for the treatment of orthostatic hypotension, including neurogenic orthostatic hypotension 5, 6, 7, 8, 9
  • It is used to increase standing systolic blood pressure and improve symptoms of orthostatic hypotension, such as dizziness, lightheadedness, weakness, fatigue, and syncope 5, 6, 7, 8, 9
  • Midodrine is also effective in improving standing time and energy level, and reducing the risk of falls and injuries associated with orthostatic hypotension 5, 6, 7, 8, 9

Contraindications for Midodrine

  • Supine hypertension: midodrine can cause supine hypertension, which can be a contraindication for its use, especially in patients with a history of hypertension or cardiovascular disease 5, 7, 8
  • Pheochromocytoma: midodrine is contraindicated in patients with pheochromocytoma, as it can cause a paradoxical increase in blood pressure 8
  • Thyrotoxicosis: midodrine is contraindicated in patients with thyrotoxicosis, as it can exacerbate the condition 8
  • Coronary artery disease: midodrine should be used with caution in patients with coronary artery disease, as it can cause an increase in blood pressure and cardiac workload 8

Special Considerations

  • Dosage: the dosage of midodrine should be individualized and titrated to achieve the desired therapeutic effect, with a typical dose range of 2.5-10 mg three times a day 6, 7, 8
  • Administration: midodrine should be taken with food to minimize gastrointestinal side effects, and the final daily dose should be taken at least 4 hours before bedtime to reduce the risk of supine hypertension 5, 8
  • Monitoring: patients taking midodrine should be monitored regularly for changes in blood pressure, heart rate, and symptoms of orthostatic hypotension, as well as for potential side effects such as piloerection, pruritus, and urinary retention 5, 6, 7, 8, 9

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.