What medication is used for hypotension?

From the Guidelines

Medication for Hypotension

Midodrine hydrochloride is commonly used for the management of low blood pressure, also known as hypotension, due to its ability to exert a pressor effect through both arteriolar constriction and venoconstriction of the capacitance vessels 1.

• The typical dosage of midodrine is up to 10 mg/day, administered orally two to four times a day, with the first dose taken before arising and use avoided several hours before planned recumbency, particularly in patients with documented supine hypertension 1.
• Alternatively, fludrocortisone may be prescribed at a dose of 0.05–0.1 mg daily, with individual titration to 0.1–0.3 mg daily, often in combination with increased salt intake to help raise blood pressure 1.
• Other possible treatments include desmopressin acetate, somatostatin analogues, caffeine, and acarbose, although these may be considered in specific cases or when first-line treatments are not effective 1.
• It's worth noting that the choice of medication should be based on the individual patient's needs and medical history, and the potential risks of a drug should be weighed against its possible benefit, including the balance between the goal of increasing standing blood pressure and the avoidance of a marked supine hypertension 1.

From the FDA Drug Label

Midodrine hydrochloride tablets are indicated for the treatment of symptomatic orthostatic hypotension (OH) Midodrine forms an active metabolite, desglymidodrine, that is an alpha1-agonist, and exerts its actions via activation of the alpha-adrenergic receptors of the arteriolar and venous vasculature, producing an increase in vascular tone and elevation of blood pressure. The medication used for hypotension is midodrine (PO), which is indicated for the treatment of symptomatic orthostatic hypotension (OH) 2.

• Key points:
  • Midodrine works by increasing vascular tone and elevating blood pressure through its active metabolite, desglymidodrine 2.
  • It is essential to carefully evaluate and monitor patients for supine and sitting hypertension when using midodrine 2.

From the Research

Medication for Hypotension

• Midodrine hydrochloride is an alpha-mimetic drug that has been shown to increase blood pressure in patients with chronic hypotension 3, 4, 5, 6.
• Midodrine has been found to be effective in treating orthostatic hypotension in patients with familial dysautonomia 4 and neurogenic orthostatic hypotension 5, 6.
• The typical dose of midodrine used to treat hypotension is 2.5-10 mg, taken two to three times a day 3, 5, 6.
• Other medications that have been used to treat primary orthostatic hypotension include droxidopa, fludrocortisone, pyridostigmine, atomoxetine, and sympathomimetic agents 7.
• Midodrine and droxidopa have the most evidence supporting their use in increasing blood pressure and alleviating symptoms of orthostatic hypotension 7.

Efficacy of Midodrine

• Midodrine has been shown to significantly increase standing systolic blood pressure in patients with neurogenic orthostatic hypotension 5, 6.
• Midodrine has also been found to improve symptoms of orthostatic hypotension, including dizziness, weakness, and fatigue 5, 6.
• The efficacy of midodrine has been demonstrated in several studies, with response rates ranging from 60-80% 3, 4, 5, 6.

Safety and Tolerability

• Midodrine is generally well-tolerated, with mild to moderate side effects reported in most studies 3, 4, 5, 6.
• Common side effects of midodrine include scalp pruritus, supine hypertension, and urinary urgency 5, 6.
• The safety and tolerability of midodrine have been established in several studies, with no significant differences in adverse events compared to placebo 5, 6.