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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. 
















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