Skip to main content

Midodrine


FDA use:      Symptomatic Orthostatic Hypotension


  • 10 mg ORALLY 3 times daily at 3- to 4-hour intervals 
  • Last dose 3-4 hours before sleeping
Renal dosing: Renal impairment: starting dose 2.5 mg



After initiation of treatment, Midodrine should be continued only for patients who report significant symptomatic improvement. 

Mechanism of Action: Midodrine forms an active metabolite, desglymidodrine, an alpha1-agonist, activates the alpha-adrenergic receptors of the arteriolar and venous vasculature, producing an increase in vascular tone and elevation of blood pressure. 

Desglymidodrine diffuses poorly across the blood-brain barrier, and is not associated with central nervous system effects. 


Pharmacological Classification: Vasopressor/Antihypotensive

CONTRAINDICATIONS:

Midodrine/ProAmatine® is contraindicated in patients with severe organic heart disease, acute renal disease, urinary retention, pheochromocytoma or thyrotoxicosis. 

Midodrine should be used cautiously in patients with urinary retention problems, as desglymidodrine acts on the alpha-adrenergic receptors of the bladder neck. 

Midodrine should not be used in patients with persistent and excessive supine hypertension. 

 It is essential to monitor supine and sitting blood pressures in patients maintained on Midodrine. Uncontrolled hypertension increases the risk of cardiovascular events, particularly stroke. 

1. Supine hypertension can often be controlled by preventing the patient from becoming fully supine, i.e., sleeping with the head of the bed elevated. 

2. The patient should be cautioned to report symptoms of supine hypertension immediately. Symptoms may include cardiac awareness, pounding in the ears, headache, blurred vision, etc. The patient should be advised to discontinue the medication immediately if supine hypertension persists. 

Monitor blood pressure when using concomitantly with other agents that cause vasoconstriction, such as phenylephrine, ephedrine, dihydroergotamine, phenylpropanolamine, or pseudoephedrine.

 A slight slowing of the heart rate may occur after administration primarily due to vagal reflex. 

Caution should be exercised when using concomitantly with cardiac glycosides (such as digitalis), psychopharmacologic agents, beta blockers or other agents that directly or indirectly reduce heart rate.


Patients who experience any signs or symptoms suggesting bradycardia (pulse slowing, increased dizziness, syncope, cardiac awareness) should be advised to discontinue Midodrine or re-evaluated. 
















Comments

Post a Comment

Popular posts from this blog

Mounjaro, Is it a game changer for weight loss and diabetes?

  MOUNJARO™ ( Tirzepatide) was approved for medical use in the United States in May 2022 WEIGHT LOSS: (Not approved by FDA for weight loss) Eli Lilly and Company is  finalizing an application to the U.S. Food and Drug Administration for fast-track approval to sell tirzepatide for chronic weight management. MOUNJARO™ is a glucose-dependent insulinotropic polypeptide (GIP) receptor and glucagon-like peptide-1 (GLP-1) receptor agonist indicated in adults for type 2 diabetes mellitus management. CONTRAINDICATIONS Personal or family history of medullary thyroid carcinoma or in patients with Multiple Endocrine Neoplasia syndrome type 2  Known serious all to tirzepatide or any of the excipients in MOUNJARO                                                                    ...
Post a Comment
Read more

Thyroid health- Quality of Life

  Let's get a TSH blood test for our family and friends Normal serum TSH ranges are higher in the  people age 70 to 80 years ; based on this, higher serum TSH goals may be needed as a patient ages.  The American Thyroid Association (ATA) suggests raising the target serum TSH to 4-6 m IU/L for 70 years-old and up The thyroid is a small, butterfly-shaped hormone-producing gland located at the front of the neck. The thyroid gland secretes two main hormones:  thyroxine (T-4) and triiodothyronine (T-3).   These hormones regulate energy levels, metabolism of fats, proteins and carbohydrates, body temperature, heart rate.  Hypothyroidism happens when the underactive thyroid gland doesn't make enough hormones. Hypothyroidism affects up to 10% of the general population (5% undiagnosed) . A n autoimmune disease called Hashimoto's diseas e where our body  makes antibodies that attack healthy thyroid tissues  is the most common cause of hypothyroidism in soc...
Post a Comment
Read more

Heart healthy

*Clinical atherosclerotic cardiovascular disease (ASCVD) includes acute coronary syndrome (ACS), those with history of myocardial infarction (MI), stable or unstable angina or coronary or other arterial revascularization, stroke, transient ischemic attack (TIA), or peripheral artery disease (PAD) including aortic aneurysm, all of atherosclerotic origin. Should I initiate statins or not? The 2014 National Lipid Association (NLA) recommendations provides a more comprehensive, patient-centered approach to identifying ASCVD risk.   In 2013, the American College of Cardiology and the American Heart Association (ACC/AHA) issued guidelines to use the intensity of statin therapy as the treatment goal instead of LDL-C or non–HDL-C targets, as in previous guidelines, to reduce atherosclerotic cardiovascular disease (ASCVD) risk (  Andrus & Lacaille, 2014  )  The guideline classifies statin therapy as  high-intensity (lowers LD...
7 comments
Read more