Midodrine


Concise Prescribing Info
Indications/Uses
Orthostatic hypotension
Dosage/Direction for Use
Adult : PO Initial: 2.5 mg 2-3 times/day, adjust as needed, up to 10 mg tid.
Dosage Details
Oral
Orthostatic hypotension
Adult: Initially, 2.5 mg 2-3 times daily, adjusted gradually according to response at weekly intervals, up to 10 mg tid. Last dose of the day should not be taken after evening meal or <4 hr before bedtime to reduce potential for supine HTN.
Renal Impairment
Initially, 2.5 mg 2-3 times daily, gradually increased as tolerated.
Administration
Should be taken with food.
Contraindications
Severe organic heart disease (e.g. bradycardia, ischaemic heart disease, CHF), acute renal failure, urinary retention, phaeochromocytoma, thyrotoxicosis, persistent and excessive supine HTN.
Special Precautions
Patient w/ DM, history of visual problems (esp when taken w/ fludrocortisone). Hepatic and renal impairment. Pregnancy and lactation.
Adverse Reactions
Supine and sitting HTN, bradycardia, paraesthesia, pilomotor reaction, chills, pruritus, rash; urinary urge, urinary retention, urinary frequency; headache, fullness in the head, vasodilation, flushing face, confusion, dry mouth, anxiety. Rarely, visual field defect, dizziness, skin hyperaesthesia, insomnia, somnolence, erythema multiforme, canker sore, dry skin; dysuria, impaired urination, asthenia, backache, pyrosis, GI distress, flatulence, leg cramps.
MonitoringParameters
Monitor supine and sitting BP; hepatic and renal function.
Overdosage
Symptoms: HTN, piloerection, coldness, urinary retention. Management: Induce emesis. Admin of α-sympatholytic drugs (e.g. phentolamine) may be beneficial.
Drug Interactions
Enhanced pressor effects w/ α-adrenergic agonists (e.g. phenylephrine, ephedrine, dihydroergotamine, phenylpropanolamine, pseudoephedrine). Reduced effect w/ α-adrenergic blockers (e.g. prazosin, terazosin, doxazosin). May precipitate bradycardia, AV block, or arrhythmia w/ cardiac glycosides.
Action
Description: Midodrine, a direct-acting sympathomimetic amine, is a prodrug which forms an active metabolite, desglymidodrine. It selectively activates the α1-adrenergic receptors of the arteriolar and venous vasculature, producing peripheral vasoconstriction and elevation of BP.
Onset: Approx 1 hr.
Duration: 2-3 hr.
Pharmacokinetics:
Absorption: Well absorbed from the GI tract. Bioavailability: 93% (desglymidodrine). Time to peak plasma concentration: 30 min (midodrine); 1-2 hr (desglymidodrine).
Distribution: Poorly crosses the blood brain barrier. Plasma protein binding: <30%.
Metabolism: Metabolised in the liver and other tissues. Undergoes rapid deglycination into its active metabolite, desglymidodrine.
Excretion: Via urine (80% as desglymidodrine). Elimination half-life: 25 min (midodrine); approx 3-4 hr (desglymidodrine).
Chemical Structure

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Storage
Store between 20-25˚C. Protect from light and moisture.
MIMS Class
ATC Classification
C01CA17 - midodrine ; Belongs to the class of adrenergic and dopaminergic cardiac stimulants excluding glycosides. Used in the treatment of hypotension.
Disclaimer: This information is independently developed by MIMS based on Midodrine from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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