From the Guidelines
To increase blood pressure and heart rate, the most effective tablet would be ephedrine, given its ability to temporarily boost both heart rate and blood pressure, especially in acute situations. When considering medications to increase blood pressure and heart rate, it's crucial to understand the underlying condition causing the low blood pressure, as the treatment should be tailored to the specific cause. For chronic conditions like orthostatic hypotension, medications such as midodrine (ProAmatine) and fludrocortisone (Florinef) are commonly prescribed, with midodrine starting at 2.5-5mg three times daily and fludrocortisone at 0.1-0.2mg daily 1. However, for acute situations where a rapid increase in blood pressure and heart rate is necessary, ephedrine tablets (25-50mg) can be an effective option, acting quickly to constrict blood vessels and increase heart rate. It's essential to note that these medications can have side effects, including headache, urinary retention, and supine hypertension, emphasizing the need for regular monitoring and a proper medical diagnosis before initiating treatment. The choice of medication should be based on the patient's specific condition, the severity of the low blood pressure, and the presence of any underlying health issues that could be affected by the medication, as discussed in guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1. In real-life clinical practice, the goal is to improve morbidity, mortality, and quality of life, and thus, the selection of a medication to increase blood pressure and heart rate must be made with these outcomes in mind, considering the most recent and highest quality evidence available.
From the FDA Drug Label
Blood pressure should be monitored carefully when midodrine is used concomitantly with other agents that cause vasoconstriction, such as phenylephrine, ephedrine, dihydroergotamine, phenylpropanolamine, or pseudoephedrine. The midodrine tablet can be used to increase blood pressure.
- Midodrine is an alpha-adrenergic agonist that acts to increase blood pressure.
- It should be used with caution in patients with certain medical conditions, such as urinary retention problems, diabetes, and visual problems.
- Patients should be advised to take their last daily dose of midodrine 3 to 4 hours before bedtime to minimize nighttime supine hypertension 2.
- Midodrine may also cause an increase in heart rate.
From the Research
Tablet to Increase Blood Pressure and Heart Rate
- Midodrine is a peripheral alpha-adrenergic agonist that can increase standing blood pressure and improve symptoms of orthostatic hypotension, such as weakness, syncope, blurred vision, and fatigue 3, 4.
- Midodrine has been shown to be effective in increasing 1-minute standing systolic blood pressure compared with placebo, and also improves standing time and energy level and clinical symptoms of orthostatic hypotension 4.
- The most commonly experienced adverse effects of midodrine are piloerector reactions, gastrointestinal disorders, and cardiovascular complaints, which are generally mild and can be controlled by reducing the dosage of midodrine 3.
- Midodrine has been compared to other sympathomimetic agents, such as norfenefrine, etilefrine, dimetofrine, and ephedrine, and has been found to be clinically at least as effective, with less frequent and severe adverse effects 3, 4.
Effect on Heart Rate
- Midodrine does not appear to cause significant cardiac stimulation, and its use is not associated with an increase in heart rate 3.
- However, midodrine has been found to cause bradycardia (a decrease in heart rate) in some patients, particularly when used as an adjunctive therapy to liberate patients from intravenous vasopressors 5, 6.
Clinical Use
- Midodrine is approved for the treatment of orthostatic hypotension, and its use has evolved to target vasoplegic conditions such as intradialytic hypotension in the end-stage renal disease population, refractory ascites in cirrhotic patients, and hepatorenal syndrome 7.
- Midodrine has been found to be well-tolerated at oral doses of 2.5 mg, 5 mg, and 10 mg, with the most frequently occurring side effects relating directly to its sympathomimetic profile 7.