Is midodrine (Midodrine) appropriate for a patient with impaired renal function on dialysis?

From the Guidelines

Midodrine is an appropriate treatment option for patients on dialysis experiencing intradialytic hypotension, as it has been shown to minimize hypotensive events and improve hemodynamic stability during dialysis sessions. According to the most recent and highest quality study available, midodrine can be given at doses of 2.5-10 mg about 30 minutes before dialysis sessions to help maintain blood pressure during treatment 1. The medication works as an alpha-1 adrenergic agonist, increasing peripheral vascular resistance and blood pressure by causing vasoconstriction, which can help stabilize hemodynamics and improve dialysis tolerance.

Key considerations for the use of midodrine in dialysis patients include:

• Monitoring for supine hypertension
• Avoiding use in patients with severe heart disease or acute kidney injury
• Adjusting dosing based on individual response
• Administering the medication 30 minutes before dialysis sessions
• Potential use between dialysis sessions for patients with persistent hypotension, usually at 2.5-10 mg three times daily (with the last dose at least 4 hours before bedtime to avoid supine hypertension)

It is essential to note that midodrine is effectively cleared by hemodialysis (HD) and its half-life is reduced to 1.4 hours by HD, which may impact dosing strategies 1. Overall, midodrine can be a valuable treatment option for managing intradialytic hypotension in dialysis patients, but its use should be carefully considered and monitored by a healthcare provider.

From the FDA Drug Label

Midodrine use has not been studied in patients with renal impairment Because desglymidodrine is eliminated via the kidneys, and higher blood levels would be expected in such patients, midodrine should be used with caution in patients with renal impairment, with a starting dose of 2. 5 mg [seeDOSAGE AND ADMINISTRATION]. Renal function should be assessed prior to initial use of midodrine.

Midodrine should be used with caution in patients with renal impairment, as the drug has not been studied in this population and higher blood levels are expected due to decreased elimination via the kidneys.

• A starting dose of 2.5 mg is recommended for patients with renal impairment.
• Renal function should be assessed prior to initial use of midodrine 2.

From the Research

Midodrine Use in Dialysis Patients

• Midodrine has been studied as a potential treatment for intradialytic hypotension in patients on dialysis 3, 4, 5.
• The studies suggest that midodrine can increase blood pressure and reduce symptoms associated with dialysis hypotension, such as cramps, fatigue, dizziness, and weakness 3, 4, 5.
• The typical dose of midodrine used in these studies was between 2.5-10 mg, given 15-30 minutes before dialysis 3, 4, 5.

Efficacy and Safety

• The studies found that midodrine was effective in increasing blood pressure and reducing symptoms of intradialytic hypotension 3, 4, 5.
• Midodrine was also found to be well-tolerated, with few adverse effects reported, such as piloerection, pruritus, and urinary retention 6, 7.
• However, the risk of supine hypertension was noted as a potential concern, which can be reduced by taking the final daily dose at least 4 hours before bedtime 6.

Clinical Use

• Based on the available evidence, midodrine appears to be a safe and effective treatment option for patients on dialysis who experience intradialytic hypotension 3, 4, 5.
• The use of midodrine in this population may help to reduce symptoms and improve blood pressure control, although further studies are needed to confirm its long-term efficacy and safety 5.