What is Midodrine used for?

From the Guidelines

Midodrine is used to treat orthostatic hypotension, a condition where blood pressure drops when standing up, causing dizziness or fainting [ 1 ].

Key Points

• Midodrine is an orally administered alpha-adrenergic agonist that works by constricting blood vessels and increasing blood pressure [ 1 ].
• The typical starting dose is 2.5mg to 10mg three times daily, with a maximum recommended dose of 40mg per day [ 1 ].
• Treatment duration is individualized based on patient response, and midodrine should be taken during waking hours, approximately 30 minutes before activities that may exacerbate orthostatic hypotension [ 1 ].
• Efficacy is typically assessed after 1-2 weeks of therapy [ 1 ].
• Midodrine is also used to prevent intradialytic hypotension in patients undergoing hemodialysis [ 1 ].
• Common side effects include pilomotor reactions, pruritus, supine hypertension, bradycardia, gastrointestinal symptoms, and urinary retention [ 1 ].

Important Considerations

• Midodrine is the only medication approved by the FDA for the treatment of symptomatic orthostatic hypotension [ 1 ].
• Patients with supine hypertension should be cautious when taking midodrine, as it can worsen this condition [ 1 ].
• Midodrine may interact with other medications, such as beta blockers and diuretics, which can affect its efficacy or increase the risk of side effects [ 1 ].

From the FDA Drug Label

Midodrine hydrochloride tablets are indicated for the treatment of symptomatic orthostatic hypotension (OH) Midodrine is used for the treatment of symptomatic orthostatic hypotension (OH). The primary goal of treatment is to improve symptoms, and it should be used in patients whose lives are considerably impaired despite standard clinical care. Key points about midodrine use include:

• Indicated for symptomatic orthostatic hypotension (OH)
• Should be used in patients with significant impairment despite standard care
• Treatment should be continued only for patients who report significant symptomatic improvement 2

From the Research

Uses of Midodrine

• Midodrine is used in the management of orthostatic hypotension, a condition characterized by a sudden drop in blood pressure when standing up from sitting or lying down 3, 4, 5, 6.
• It is also used to treat neurogenic orthostatic hypotension, a type of orthostatic hypotension that occurs in patients with nervous system disorders 5.
• Additionally, midodrine has been used to treat orthostatic hypotension in patients with familial dysautonomia, a rare genetic disorder that affects the nervous system 6.
• Midodrine has also been studied as an adjunctive treatment for refractory hypotension in intensive care unit (ICU) patients, with the goal of reducing the duration of intravenous vasopressor treatment and allowing for earlier discharge from the ICU and hospital 7.

Benefits of Midodrine

• Midodrine has been shown to increase standing systolic blood pressure and improve symptoms of orthostatic hypotension, such as dizziness, lightheadedness, and syncope 3, 4, 5.
• It has also been shown to improve standing time and energy level in patients with orthostatic hypotension 3.
• Midodrine is generally well-tolerated, with common side effects including piloerection, pruritus, and urinary retention 3, 4.

Dosage and Administration

• The typical dosage of midodrine is 2.5-10 mg three times a day, with the final dose taken at least 4 hours before bedtime to reduce the risk of supine hypertension 3, 5.
• The dosage may need to be adjusted based on the patient's response to treatment and the presence of any side effects 3, 4, 5, 6.