From the FDA Drug Label
The patient should be advised to discontinue the medication immediately if supine hypertension persists Patients who experience any signs or symptoms suggesting bradycardia (pulse slowing, increased dizziness, syncope, cardiac awareness) should be advised to discontinue midodrine hydrochloride and should be re-evaluated. The supine and standing blood pressure should be monitored regularly, and the administration of midodrine hydrochloride tablets should be stopped if supine blood pressure increases excessively
Midodrine should be held in the following situations:
- Supine hypertension: if it persists
- Bradycardia: if the patient experiences any signs or symptoms suggesting bradycardia
- Excessive increase in supine blood pressure: if the supine blood pressure increases excessively 1 1
From the Research
Midodrine should be held when a patient's blood pressure is elevated, in supine positions, or at least 4 hours before bedtime, and in cases of severe side effects or certain medical conditions, as evidenced by the most recent study 2. When considering the indications to hold midodrine, it's crucial to prioritize the patient's safety and prevent potential complications. The medication is an alpha-1 adrenergic agonist that increases blood pressure by causing peripheral vasoconstriction.
- Key considerations for holding midodrine include:
- Elevated blood pressure (typically systolic BP >180 mmHg or diastolic BP >100 mmHg) 2
- Supine position, as this can lead to dangerous elevations in blood pressure
- At least 4 hours before bedtime to prevent supine hypertension during sleep, which can increase the risk of stroke or other cardiovascular complications 3
- Severe side effects such as piloerection (goosebumps), scalp tingling, urinary retention, or supine hypertension
- Certain medical conditions, including severe heart disease, acute kidney injury, urinary retention, pheochromocytoma, or thyrotoxicosis, as these may be exacerbated by midodrine The most recent study 2 highlights the importance of careful consideration when prescribing midodrine, particularly in older adults with orthostatic hypotension, due to the potential for novel adverse events such as nightmares.
- Additionally, other studies 4, 3, 5, 6 provide further insight into the pharmacological properties, therapeutic use, and potential side effects of midodrine, but the most recent study 2 takes precedence in guiding clinical decision-making.