From the Research
Administration of Midodrine
The administration of midodrine is typically considered in cases of symptomatic orthostatic hypotension. The following points highlight the levels of hypotension at which midodrine may be administered:
- Midodrine is effective in increasing standing systolic blood pressure in patients with orthostatic hypotension, with a significant increase peaking at 1 hour after administration 1.
- A dose of 10 mg of midodrine is effective in increasing orthostatic blood pressure and ameliorating symptoms in patients with neurogenic orthostatic hypotension 1.
- In patients with intradialytic hypotension, midodrine (mean dose, 5.5 mg; range, 5 to 10 mg) administered 30 minutes before each hemodialysis session significantly improved lowest intradialytic systolic blood pressure (from 96.6 to 114.7 mm Hg; P < 0.001) 2.
- In hypotensive individuals with spinal cord injury, midodrine (10 mg) administered two or three times a day significantly increased average 30-day systolic BP (114 ± 14 vs. 96 ± 11 mmHg, respectively; P = 0.004) and reduced the number of hypotensive BP recordings compared to placebo 3.
Levels of Hypotension
The levels of hypotension at which midodrine should be administered are not strictly defined, but the following points provide some guidance:
- In patients with neurogenic orthostatic hypotension, midodrine is effective in increasing standing systolic blood pressure, with a significant increase peaking at 1 hour after administration, regardless of the level of hypotension 1.
- In patients with intradialytic hypotension, midodrine is effective in improving blood pressure at levels as low as 96.6 mm Hg 2.
- In hypotensive individuals with spinal cord injury, midodrine is effective in increasing average 30-day systolic BP at levels as low as 96 ± 11 mmHg 3.
Key Considerations
When considering the administration of midodrine, the following points should be taken into account:
- Midodrine is effective in increasing blood pressure and reducing symptoms of orthostatic hypotension, but may worsen symptoms of autonomic dysreflexia 3.
- The optimal dose and frequency of midodrine administration may vary depending on the individual patient and the specific condition being treated 1, 2, 3.