From the Guidelines
Recommended Dosing Frequency for Midodrine
Midodrine is typically administered orally in doses of 2.5 to 10 milligrams, three times daily, with the last dose given at least 4 hours before bedtime to avoid nocturnal hypertension 1.
- The dosing should be individually tailored, with a maximum of 10 mg three times daily 1, and the total daily dose should not exceed 30 milligrams.
- The first dose should be taken before arising, and use should be avoided several hours before planned recumbency, particularly in patients with documented supine hypertension 1.
- It is essential to titrate the dose according to symptoms and blood pressure, and midodrine may be poorly tolerated in heart failure patients 1.
- The treatment duration is usually limited to a few weeks or months, depending on the underlying condition being treated, such as orthostatic hypotension.
- In some cases, midodrine can be initiated at doses of 7.5 mg and titrated upward to 12.5 mg three times daily 1.
- However, the most commonly recommended dosing frequency is three times daily, with a focus on avoiding supine hypertension and titrating the dose according to individual patient response 1.
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.) The recommended dosing frequency for midodrine in treating orthostatic hypotension is 3 times daily, with doses given at approximately 4-hour intervals during daytime hours, and not more frequently than every 3 hours if required to control symptoms 2.
- The dosing schedule should be as follows:
- Shortly before, or upon arising in the morning
- Midday
- Late afternoon (not later than 6 P.M.)
- Midodrine should not be given after the evening meal or less than 4 hours before bedtime to reduce the potential for supine hypertension during sleep.
From the Research
Recommended Dosing Frequency for Midodrine
The recommended dosing frequency for midodrine in treating orthostatic hypotension is:
- 10-mg dose of midodrine prescribed two to three times daily, as found in the study 3
- Initial midodrine dose of 2.5 mg three times daily, which can be raised until subjective symptoms improve, as noted in the study 4
- Dosage of 2.5 to 5 mg three times daily, as used in the study 5
Key Findings
- Midodrine significantly increased standing systolic blood pressure, with the increase peaking at 1 hour 3
- The half-life of desglymidodrine, the active metabolite of midodrine, was approximately 4 hours 3
- Midodrine improved subjective symptoms in all patients with familial dysautonomia, at an average dose of 0.25 mg/kg per day 4
- The most frequently occurring side effects of midodrine relate directly to its sympathomimetic profile, including piloerection, scalp pruritis, generalized paresthesias, and urinary retention 6