From the FDA Drug Label
Carcinogenesis, Mutagenesis, Impairment of Fertility: ...Other than the dominant lethal assay in male mice, where no impairment of fertility was observed, there have been no studies on the effects of midodrine on fertility The answer to whether midodrine affects fertility is that no impairment of fertility was observed in male mice, but there have been no other studies on the effects of midodrine on fertility 1.
From the Research
Introduction to Midodrine and Fertility
Midodrine is a peripheral alpha-adrenergic agonist used in the management of orthostatic hypotension and secondary hypotensive disorders 2. The question of whether midodrine affects fertility is complex and requires an examination of its pharmacological properties and therapeutic use.
Mechanism of Action and Potential Effects on Fertility
Midodrine works by increasing standing blood pressure and improving symptoms of orthostatism without associated cardiac stimulation 2. However, its effects on fertility are not directly addressed in the available literature. The drug's mechanism of action as an alpha-adrenergic agonist could potentially influence fertility, particularly in patients with spinal cord injury, where it may cause an increase in the tone of the vesical sphincter, leading to progressive retention of urine 3.
Clinical Evidence and Fertility
There is limited clinical evidence directly linking midodrine to fertility issues. However, studies on other medications, such as antidepressants, suggest that certain drugs can affect fertility 4, 5. For example, selective serotonin reuptake inhibitors (SSRIs) have been shown to decrease sperm number and viability in men and may disrupt fallopian tube motility in women 5. While midodrine is not an SSRI, its potential effects on fertility should be considered, especially in patients with underlying conditions that may affect reproductive health.
Treatment Considerations and Fertility
In patients requiring midodrine for orthostatic hypotension, the dosage typically ranges from 2.5 mg to 10 mg, taken 2 to 3 times a day 3. If fertility is a concern, patients should discuss alternative treatments with their healthcare provider. For patients with spinal cord injury, intermittent catheterization and antimuscarinic therapy may be recommended instead of spontaneous voiding to manage urologic adverse effects 3.
Conclusion
While there is no direct evidence that midodrine affects fertility, its potential effects on urinary retention and other urologic adverse effects, particularly in patients with spinal cord injury, should be considered 3. Healthcare providers should weigh the benefits and risks of midodrine treatment in patients of reproductive age and discuss alternative management options if fertility is a concern. Further research is needed to fully understand the effects of midodrine on fertility.
Differential Diagnosis and Caveats
- Patients with spinal cord injury may be at higher risk for urologic adverse effects when taking midodrine 3.
- Alternative treatments, such as fludrocortisone, may be considered for patients with orthostatic hypotension who are concerned about fertility 3.
- The effects of midodrine on fertility may be dose-dependent, but more research is needed to confirm this 6.