From the Guidelines
Midodrine should be prescribed at an initial dose of 2.5 mg three times daily, with a maximum dose of 10 mg three times daily, as this dosing regimen has been shown to be effective in treating orthostatic hypotension while minimizing the risk of supine hypertension 1.
Key Considerations
- The dose of midodrine can be titrated upward as needed and tolerated, with the goal of minimizing postural symptoms rather than restoring normotension.
- The medication should be taken during daytime hours, with the last dose taken at least 3-4 hours before bedtime to avoid supine hypertension while sleeping.
- Midodrine works by activating alpha-1 adrenergic receptors, causing constriction of both arteries and veins, which increases blood pressure.
- Common side effects include piloerection (goosebumps), scalp tingling, urinary urgency, and supine hypertension.
- Blood pressure should be monitored regularly while taking midodrine, especially when initiating therapy or adjusting doses, to ensure effectiveness and avoid excessive blood pressure elevation when lying down.
Treatment Approach
- Non-pharmacological measures, such as gradual staged movements with postural change, mild isotonic exercise, and increased fluid and salt intake, should be attempted first to manage orthostatic hypotension.
- If symptoms persist, midodrine can be considered as a first-line treatment option, with the dosing regimen tailored to the individual patient's needs and response to therapy.
- Other treatment options, such as droxidopa and pyridostigmine, may also be considered, but midodrine is currently the only medication approved by the Food and Drug Administration for the treatment of symptomatic orthostatic hypotension 1.
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 dose and frequency of Midodrine (ProAmatine) for treatment is:
- Dose: 10 mg
- Frequency: 3 times daily
- Timing: During daytime hours, with a suggested schedule of approximately 4-hour intervals, and not later than 6 P.M. 2
From the Research
Recommended Dose and Frequency of Midodrine
The recommended dose and frequency of Midodrine (ProAmatine) for the treatment of orthostatic hypotension can be summarized as follows:
- A dose of 10 mg 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
- Midodrine can be administered at a dose of 2.5 mg, 5 mg, or 10 mg, three times a day, with the 10 mg dose being the most effective 4
- The final daily dose of midodrine should be taken at least 4 hours before bedtime to reduce the risk of supine hypertension 5
Key Findings
Key findings from the studies include:
- Midodrine significantly increases standing systolic blood pressure and improves symptoms of orthostatic hypotension, such as dizziness, lightheadedness, and syncope 5, 6, 7, 3, 4
- The most commonly reported adverse events associated with midodrine therapy are piloerection, pruritus, paraesthesias, urinary retention, and chills 5, 6
- Midodrine is well tolerated, with the majority of adverse events being mild to moderate 4
Dosage Considerations
Considerations for dosing midodrine include: