How to Take Midodrine
Midodrine should be taken three times daily during daytime hours only, with the last dose no later than 6 PM and at least 4 hours before bedtime to avoid supine hypertension during sleep. 1
Dosing Schedule
- Standard dosing: 10 mg three times daily 1
- Timing: Take at approximately 4-hour intervals during daytime only
- First dose: Upon arising in the morning
- Second dose: Midday
- Third dose: Late afternoon (not later than 6 PM)
- Alternative timing: Doses may be given at 3-hour intervals if needed to control symptoms, but not more frequently 1
Important Administration Guidelines
- Never take before sleep: Midodrine should not be given after the evening meal or less than 4 hours before bedtime 1
- Maximum daily dose: Total daily doses should not exceed 30 mg 1
- Sleeping position: Sleep with the head of the bed elevated (10°) to reduce risk of supine hypertension 2
- Monitoring: Regular blood pressure monitoring in both supine and standing positions is essential 1
Special Populations
- Renal impairment: For patients with abnormal kidney function, start with lower doses (2.5 mg) 1
- Elderly patients: No dose adjustments necessary based on age 1
Specific Use Cases
- Orthostatic hypotension: Standard dosing as above 3
- Hepatorenal syndrome: Starting dose of 7.5 mg three times daily, which can be increased to 12.5 mg three times daily as needed 2
- Refractory ascites: 7.5 mg three times daily 3
Potential Side Effects to Monitor
- Piloerection (goosebumps)
- Scalp itching or tingling
- Urinary urgency or retention
- Supine hypertension (in up to 25% of patients) 4
- Headache
- Nausea
When to Stop or Adjust Therapy
- If supine blood pressure increases excessively 1
- If urinary retention develops 5
- If no symptomatic improvement is observed during initial treatment 1
Contraindications
- Acute kidney injury with serum creatinine ≥5 mg/dL 3
- Severe heart failure
- Uncontrolled hypertension
By following these guidelines, patients can maximize the benefits of midodrine therapy while minimizing the risk of adverse effects, particularly supine hypertension, which is the most concerning potential complication of this medication.