Midodrine (alpha-receptor agonist, vasoconstrictor)

Midodrine is a drug known as a sympathomimetic (alpha-receptor agonist). It acts on the blood vessels to raise blood pressure.

Uses

What is midodrine used for?

This medication is used for certain patients who have symptoms of low blood pressure when standing. This condition is also known as orthostatic hypotension. Midodrine also has several off-label uses.

How should I take midodrine?

Take this medication by mouth with or without food as directed by your doctor, usually 3 times daily (at least 3 to 4 hours between doses). Follow all your doctor’s instructions carefully. This drug is taken during daytime hours when people stand most often. This medicine should not be taken after the evening meal or less than 4 hours before bedtime. Taking your dose is not recommended if you plan to lie down for a long time afterward (e.g., taking a nap).

Tell your doctor if your condition persists or worsens. This drug should be continued only in those people whose symptoms improve during treatment.

How do I store Midodrine?

This product is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store it in the bathroom or the freezer. 

There may be different brands of this drug that may have different storage needs. So, it is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush this product down the toilet or pour them into a drain unless instructed to do so. Additionally, it is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & Warnings

What should I know before using Midodrine?

Before using this drug, tell your doctor if you are/have:

Midodrine may cause blurring of vision, so do not take it if you need to drive or operate machinery.

Is it safe during pregnancy or breast-feeding?

Unfortunately, there isn’t enough information about the safety of using this drug during pregnancy and breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking any medication.

This medication is pregnancy risk category C according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

• A=No risk
• B=No risk in some studies
• C=There may be some risk
• D=Positive evidence of risk
• X=Contraindicated
• N=Unknown

Side Effects

What side effects can occur from Midodrine?

Like all drugs, this product may have side effects. If they occur, side effects are generally mild and resolve once treatment is finished or the dose is lowered. Some reported side effects include:

• Skin tingling, chills, or “goose bumps’
• Stomach pain
• Urinary problems
• Dry mouth
• Dizziness
• Drowsiness
• Insomnia
• Leg cramps
• Increased blood pressure (supine and sitting hypertension)

• Pounding heartbeat
• Headache
• Blurred vision

However, not everyone experiences these side effects. In addition, some people may experience other side effects. So, if you have any concerns about a side effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with Midodrine?

This medication may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. 

To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs, and herbal products) and share it with your doctor and pharmacist. 

Drugs with known interactions:

• Other alpha-adrenergic agonists (e.g. phenylephrine, pseudoephedrine)
• Alpha-adrenergic blockers (e.g. prazosin)
• Cardiac glycosides

If you experience an adverse drug interaction, stop taking this drug and continue taking your other medication. Inform your doctor immediately to reevaluate your treatment plan. Approaches include dose adjustment, drug substitution, or ending therapy.

Does food or alcohol interact with Midodrine?

This drug may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with Midodrine?

This drug may interact with underlying conditions. This interaction may worsen your health condition or alter the way the drug works. Therefore, it is important to always let your doctor and pharmacist know all the health conditions you currently have.

Dosage

The information provided is not a substitute for any medical advice. Therefore, you should always consult with your doctor or pharmacist before using any medication.

What is the dose for an adult?

Hypotension

Take 10 mg by mouth 3 times a day during daytime hours when the patient needs to be upright.

Renal Dose Adjustments

CrCl less than 90 mL/min: Initiate treatment using 2.5 mg doses

Acute renal disease: Contraindicated

What is the dose for a child?

There is no established pediatric dose. It may be unsafe for your child. It is always important to fully understand the safety of the drug before using. Please consult with your doctor or pharmacist for more information.

How is Midodrine available?

Midodrine is available in the following dosage forms and strengths:

• Oral tablet 2.5 mg, 5 mg, 10 mg

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to the nearest emergency room. To manage an overdose, induce emesis (vomiting) and/or administer alpha-receptor blockers (α-sympatholytics) .

What should I do if I miss a dose?

If you miss a dose, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.