Formulary
Midodrine hydrochloride: Indications, Dosing, Side Effects and Interactions
Midodrine hydrochloride is a pro-drug of desglymidodrine.
MedNext Academy | 3 min read
Midodrine hydrochloride: Indications, Dosing, Side Effects and Interactions
Midodrine hydrochloride is a pro-drug of desglymidodrine.
Drug action
Midodrine hydrochloride is a pro-drug of desglymidodrine. Desglymidodrine is a sympathomimetic agent, which acts on peripheral alpha-adrenergic receptors to increase arterial resistance, resulting in an increase in blood pressure.
Indications and dose
**Severe orthostatic hypotension due to autonomic dysfunction when corrective factors have been ruled out and other forms of treatment are inadequate**
- **Adult** (By Mouth): Initially 2.5 mg 3 times a day, increased if necessary up to 10 mg 3 times a day, dose to be increased at weekly intervals, according to blood pressure measurements; usual maintenance 10 mg 3 times a day, avoid administration at night; the last daily dose should be taken at least 4 hours before bedtime.
Cautions
Atherosclerotic cardiovascular disease (especially with symptoms of intestinal angina or claudication of the legs); autonomic dysfunction; elderly (manufacturer recommends cautious dose titration); prostate disorders
Contraindications
Aortic aneurysm; blood vessel spasm; bradycardia; cardiac conduction disturbances; cerebrovascular occlusion; congestive heart failure; hypertension; hyperthyroidism; myocardial infarction; narrow-angle glaucoma; phaeochromocytoma; proliferative diabetic retinopathy; serious obliterative blood vessel disease; serious prostate disorder; urinary retention
Side effects
Common or very common Chills; flushing; gastrointestinal discomfort; headache; nausea; paraesthesia; piloerection; scalp pruritus; skin reactions; stomatitis; supine hypertension (dose-dependent); urinary disorders Uncommon Anxiety; arrhythmias; irritability; sleep disorders Rare or very rare Hepatic function abnormal; palpitations Frequency not known Confusion; diarrhoea; vomiting Side-effects, further information Manufacturer advises that treatment must be stopped if supine hypertension is not controlled by reducing the dose.
Interactions
**Other interactions (6):**
- Sympathomimetics and other vasopressor agents Concomitant treatment with sympathomimetics and other vasoconstrictive substances such as reserpine, guanethidine, tricyclic antidepressants,...
- Alpha-adrenergic antagonists As with other specific -adrenergic agonists, the effect of midodrine is blocked by -adrenergic antagonists such as prazosin and phentolamine.
- Corticosteroid preparations Midodrine may potentiate or enhance the hypertensive effects of corticosteroid preparations.
- Concomitant administration of drugs that inhibit this enzyme (e.g.
- Potential effect of midodrine on other drugs Midodrine is an inhibitor of CYP2D6 and may affect the metabolism of other drugs.
- This may be of clinical relevance for active substances that are mainly metabolized by CYP2D6, e.g.
Pregnancy
Manufacturer advises avoid-toxicity in animal studies.
Breast feeding
Manufacturer advises avoid-no information available.
Renal impairment
Manufacturer advises avoid in severe or acute impairment.
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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