From the Guidelines
Midodrine is contraindicated in patients with severe heart disease, acute kidney failure, urinary retention, pheochromocytoma, thyrotoxicosis, and persistent and excessive supine hypertension, as well as in patients with severe organic heart disease, hypertension, or those at risk for hypertension. The medication should be used cautiously in patients with CHF and in those using other negative chronotropic agents such as beta-blockers, digoxin and nondihydropyridine CCBs 1. Some of the key contraindications and precautions for midodrine include:
- Severe heart disease
- Acute kidney failure
- Urinary retention
- Pheochromocytoma
- Thyrotoxicosis
- Persistent and excessive supine hypertension (blood pressure >180/110 mmHg when lying down)
- Severe organic heart disease
- Hypertension or those at risk for hypertension
- Concomitant use with other-adrenergic agents—such as ephedrine, pseudoephedrine and phenylpropanolamine—should be avoided, as this may aggravate supine hypertension 1. Midodrine can also antagonize the actions of -adrenergic blockers (such as terazosin, prazosin and doxazosine) and could result in urinary retention 1. Patients should be monitored for supine hypertension and advised to elevate the head of their bed at night to minimize this risk, and the medication should be taken during daytime hours when the patient will be upright, with the last dose typically at least 4 hours before bedtime to avoid dangerous blood pressure elevations while lying down. It is also important to note that midodrine does not cross the blood-brain barrier, which reduces the risk of central nervous system effects, but it can still cause side effects such as piloerection, scalp itching or tingling, nausea and heartburn, urinary urgency, headache, nervousness, and sleep disturbance 1.
From the FDA Drug Label
Midodrine hydrochloride tablets are contraindicated in patients with severe organic heart disease, acute renal disease, urinary retention, pheochromocytoma or thyrotoxicosis. Midodrine should not be used in patients with persistent and excessive supine hypertension. The contraindications for Midodrine (Midodrine hydrochloride) are:
- Severe organic heart disease
- Acute renal disease
- Urinary retention
- Pheochromocytoma
- Thyrotoxicosis
- Persistent and excessive supine hypertension 2
From the Research
Contraindications for Midodrine
The provided studies do not explicitly list contraindications for Midodrine (Midodrine hydrochloride). However, we can infer some potential contraindications based on the reported side effects and interactions:
- Supine hypertension: Midodrine can cause or exacerbate supine hypertension, as reported in 3 and 4. This could be a concern for patients with pre-existing hypertension.
- Urinary retention: Midodrine can cause urinary retention, as reported in 5 and 4. This could be a concern for patients with pre-existing urinary retention or benign prostatic hyperplasia.
- Piloerection, pruritus, and paraesthesias: Midodrine can cause these side effects, as reported in 5 and 4. While not typically contraindications, these side effects could be bothersome for some patients.
Warnings and Precautions
Based on the provided studies, the following warnings and precautions can be inferred:
- Midodrine should be used with caution in patients with hypertension, as it can exacerbate supine hypertension 3, 4.
- The final daily dose of midodrine should be taken at least 4 hours before bedtime to reduce the risk of supine hypertension 5.
- Patients with autonomic failure or neurogenic orthostatic hypotension should be monitored closely for efficacy and safety when taking midodrine 6, 4.