Is Midodrine used for Postural Orthostatic Tachycardia Syndrome (POTS)?

From the Guidelines

Midodrine is used for treating Postural Orthostatic Tachycardia Syndrome (POTS), with a recommended dose of 2.5-10 mg, taken in the morning before getting out of bed and the last dose taken no later than 4 pm. This is based on the most recent evidence from 2022, which suggests that midodrine may help with orthostatic intolerance in patients with POTS 1. Midodrine is an alpha-1 adrenergic agonist that helps increase blood pressure by constricting blood vessels, which can reduce the symptoms of POTS such as lightheadedness, dizziness, and rapid heart rate upon standing.

Some key points to consider when using midodrine for POTS include:

• Starting with a low dose and gradually increasing as needed and tolerated
• Taking the medication in an upright position and remaining upright for at least 4 hours after each dose
• Monitoring blood pressure regularly, especially when starting the medication
• Being aware of potential side effects, such as piloerection, scalp tingling, urinary retention, and supine hypertension

It's also important to note that midodrine is just one part of a comprehensive treatment plan for POTS, which may also include nonpharmacological interventions such as salt and fluid loading, elevation of the head of the bed, and use of support stockings, as well as a formalized exercise program 1.

From the FDA Drug Label

Midodrine hydrochloride tablets are indicated for the treatment of symptomatic orthostatic hypotension (OH) The FDA drug label does not answer the question.

From the Research

Midodrine Use in POTS

• Midodrine is used in the management of Postural Orthostatic Tachycardia Syndrome (POTS) as it helps to increase blood pressure and reduce symptoms of orthostatic intolerance 2, 3, 4.
• The drug is particularly useful in patients with neuropathic POTS, as it enhances vascular tone 3.
• Midodrine has been shown to suppress tachycardia in POTS patients and improve standing times in those with orthostatic intolerance 2.

Efficacy of Midodrine in POTS

• Studies have demonstrated that midodrine can be an effective treatment for POTS, especially when used in combination with other therapies 2, 4.
• The efficacy of midodrine in POTS can be predicted by analyzing changes in blood pressure during the head-up test (HUT) 4.
• Midodrine has been found to be well-tolerated in patients with POTS, with common side effects including piloerection, pruritus, and urinary retention 5.

Comparison with Other Treatments

• Midodrine has been compared to other treatments for POTS, including octreotide, and has been found to have similar potency 2.
• The choice of treatment for POTS depends on the underlying pathophysiologic mechanism, with midodrine being a useful option for patients with neuropathic POTS 3, 6.