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.) In order to reduce the potential for supine hypertension during sleep, midodrine hydrochloride tablets should not be given after the evening meal or less than 4 hours before bedtime.
The optimal timing of midodrine tid for treating orthostatic hypotension in elderly is:
- 10 mg, 3 times daily
- Dosing should occur during daytime hours
- A suggested schedule is:
- Shortly before, or upon arising in the morning
- Midday
- Late afternoon (not later than 6 P.M.)
- Not after the evening meal or less than 4 hours before bedtime 1
From the Research
The optimal timing for midodrine administration in elderly patients with orthostatic hypotension is typically three times daily at approximately 8 AM, noon, and 4 PM, with the last dose taken at least 3-4 hours before bedtime, as supported by the most recent study 2. This schedule maximizes the drug's effect during daytime hours when patients are most active and upright, while avoiding supine hypertension at night. Midodrine is a direct alpha-1 adrenergic agonist that increases vascular tone and raises blood pressure, with effects beginning within 30-60 minutes and lasting about 2-3 hours, as described in 3. Key considerations for midodrine administration include:
- Starting at a low dose of 2.5 mg per dose and gradually titrating up to 10 mg per dose based on blood pressure response and tolerability
- Taking the medication on an empty stomach if possible for better absorption
- Avoiding lying flat for 3-4 hours after each dose
- Monitoring for common side effects including urinary retention, piloerection (goosebumps), and scalp tingling
- Regularly checking blood pressure in both sitting and standing positions to assess efficacy and avoid excessive hypertension
- Discontinuing the medication if supine hypertension becomes problematic or if the patient develops cardiac issues, as noted in 4. It is essential to prioritize the patient's safety and adjust the treatment plan accordingly, considering the potential risks and benefits of midodrine therapy, as discussed in 5 and 6.