From the Guidelines
Midodrine is contraindicated in patients with severe heart disease, acute kidney injury, urinary retention, pheochromocytoma, thyrotoxicosis, persistent and excessive supine hypertension, or known hypersensitivity to the drug. When considering the use of midodrine, it is essential to weigh the potential benefits against the risks, particularly in patients with certain comorbidities. According to the study published in the American Journal of Kidney Diseases 1, midodrine should be used cautiously in patients with congestive heart failure (CHF) and in those using other negative chronotropic agents such as beta-blockers, digoxin, and non-dihydropyridine calcium channel blockers. Some key points to consider when prescribing midodrine include:
- Concomitant use with other adrenergic agents, such as ephedrine, pseudoephedrine, and phenylpropanolamine, should be avoided to prevent aggravating supine hypertension 1.
- Midodrine can antagonize the actions of alpha-adrenergic blockers, such as terazosin, prazosin, and doxazosin, which could result in urinary retention 1.
- Patients should be monitored for bradycardia, as midodrine is associated with reflex parasympathetic stimulation 1.
- Long-term use of midodrine has been associated with supine systolic hypertension in less than 10% of patients, which warrants cessation of therapy 1. It is crucial to carefully evaluate the potential risks and benefits of midodrine in each patient, taking into account their individual medical history and current medications, to minimize the risk of adverse effects and ensure optimal treatment outcomes.
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
There are no direct mentions of contraindications for Midodrine (Midodrine hydrochloride) in the provided studies. However, the following points can be considered:
- The studies primarily focus on the therapeutic use of Midodrine in managing orthostatic hypotension and its efficacy compared to other agents 3, 4.
- Midodrine is known to cause supine hypertension in up to 25% of patients, which can be a concern in certain individuals 4.
- The drug's sympathomimetic profile can lead to side effects such as piloerection, scalp pruritis, generalized paresthesias, and urinary retention 5.
- Midodrine may be used off-label in patients with heart failure with reduced ejection fraction (HFrEF) and symptomatic hypotension, but its use in this context is not widely studied 6.
- The interaction between Midodrine and other medications or conditions is not extensively discussed in the provided studies.
Potential Considerations
- Supine hypertension: Patients with a history of hypertension or those at risk of developing supine hypertension may need to be monitored closely while taking Midodrine 4.
- Sympathomimetic side effects: Patients with certain medical conditions, such as benign prostatic hyperplasia or glaucoma, may be more susceptible to the sympathomimetic side effects of Midodrine 5.
- Off-label use: The use of Midodrine in patients with heart failure or other conditions not explicitly mentioned in the studies should be approached with caution and under close medical supervision 6.