What medication is used to treat hypotension (low blood pressure)?

From the Guidelines

Midodrine and droxidopa are the most effective medications for treating orthostatic hypotension, as they are approved by the FDA for this condition and have been shown to minimize postural symptoms. According to the most recent study 1, treating orthostatic hypotension is challenging, and the therapeutic goal is to minimize postural symptoms rather than to restore normotension. Most individuals require both nonpharmacologic measures (e.g., ensuring adequate salt intake, avoiding medications that aggravate hypotension, or using compressive garments over the legs and abdomen) and pharmacologic measures.

Some key points to consider when treating orthostatic hypotension include:

• Physical activity and exercise should be encouraged to avoid deconditioning, which is known to exacerbate orthostatic intolerance, and volume repletion with fluids and salt is critical 1.
• Supine blood pressure tends to be much higher in these individuals, often requiring treatment of blood pressure at bedtime with shorter-acting drugs that also affect baroreceptor activity such as guanfacine or clonidine, shorter-acting calcium blockers (e.g., isradipine), or shorter-acting β-blockers such as atenolol or metoprolol tartrate 1.
• Alternatives can include enalapril if an individual is unable to tolerate preferred agents 1.
• Midodrine and droxidopa are the preferred pharmacologic measures for treating orthostatic hypotension, as they have been shown to be effective in minimizing postural symptoms and are approved by the FDA for this condition 1.

It's essential to note that treatment should always be supervised by a healthcare provider who will determine the appropriate medication and dosage based on the cause and severity of hypotension. Before starting medication, it's crucial to identify and address underlying causes of low blood pressure, such as dehydration or medication side effects, and to implement lifestyle changes like increasing salt and fluid intake when appropriate.

From the FDA Drug Label

Midodrine hydrochloride tablets are indicated for the treatment of symptomatic orthostatic hypotension (OH) Midodrine forms an active metabolite, desglymidodrine, that is an alpha1-agonist, and exerts its actions via activation of the alpha-adrenergic receptors of the arteriolar and venous vasculature, producing an increase in vascular tone and elevation of blood pressure.

The medication used to treat hypotension (low blood pressure) is midodrine.

• Key points:
  • Midodrine is indicated for the treatment of symptomatic orthostatic hypotension (OH)
  • It works by increasing vascular tone and elevating blood pressure through its active metabolite, desglymidodrine, an alpha1-agonist
  • Midodrine should be used in patients whose lives are considerably impaired despite standard clinical care 2 2

From the Research

Medication for Hypotension

• Midodrine is a medication used to treat orthostatic hypotension, which is a form of low blood pressure that occurs when standing up from sitting or lying down 3, 4, 5, 6.
• It works by increasing blood pressure and improving symptoms such as dizziness, lightheadedness, and fatigue 3, 4.
• Midodrine is a prodrug that is converted to its active form, desglymidodrine, after oral administration, and it has been shown to be effective in increasing standing systolic blood pressure and improving symptoms of orthostatic hypotension 3, 4.
• The medication has been compared to other treatments, such as dihydroergotamine mesylate, norfenefrine, fludrocortisone, and etilefrine, and has been found to be similarly effective or more effective in some cases 3.
• Midodrine is generally well-tolerated, but common side effects include piloerection, pruritus, paraesthesias, urinary retention, and chills 3, 4.
• The risk of supine hypertension, which can occur with midodrine therapy, can be reduced by taking the final daily dose at least 4 hours before bedtime 3.

Treatment Outcomes

• Studies have shown that midodrine can be an effective treatment for orthostatic hypotension, with significant improvements in standing systolic blood pressure and symptoms 4, 5.
• However, the effectiveness of midodrine may depend on the individual patient and the severity of their orthostatic hypotension, with some patients experiencing greater benefits than others 5.
• Midodrine has been licensed in the UK for the treatment of severe orthostatic hypotension due to autonomic dysfunction in adults 6.
• Research has also shown that patients with orthostatic hypotension may not persist with treatment for long periods, with median persistence on midodrine and fludrocortisone being around 254-259 days 7.