Treatment of symptomatic orthostatic hypotension in patients whose lives are considerably impaired despite standard clinical care (including non-pharmacologic treatment). It can cause marked elevation of supine blood pressure.
Also known as: Gutron
DailyMed approved label (Midodrine Hydrochloride Tablet, Northstar Rx; setID 79b712a3-be12-4ea6-ac42-742826685ae5).
DailyMed approved label (Midodrine Hydrochloride Tablet, Northstar Rx; setID 79b712a3-be12-4ea6-ac42-742826685ae5).
Midodrine may potentiate digoxin bradycardia.
Midodrine (alpha-1 agonist) increases reflex vagal tone and digoxin has negative chronotropic and dromotropic effects: the combination can cause marked bradycardia and conduction blocks, especially in elderly patients with sinus node dysfunction. Digoxin itself also increases automaticity at toxic levels, so the ECG should be monitored. Monitor heart rate and ECG, use the lowest effective midodrine doses and watch for hypoperfusion symptoms (dizziness, syncope) and digitalis toxicity signs.
Midodrine + digoxin: additive negative chronotropic effect (bradycardia) and arrhythmia risk. Monitor heart rate and ECG.
Midodrine (alpha-1 agonist) reflexively lowers heart rate; digoxin also slows AV conduction.
Heart rate, BP, bradycardia symptoms.
Symptomatic bradycardia or supine hypertension.
Watch heart rate and blood pressure.
DailyMed (FDA) — approved Midodrine label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=79b712a3-be12-4ea6-ac42-742826685ae5 ; approved Digoxin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e61d2108-d871-44c0-b12a-2e61fbb56967 — additional reference: Prontuário Terapêutico do INFARMED (11th ed., 2012)
Caffeine may potentiate the pressor effect of midodrine.
Limit caffeine intake.
EMC-UK (MHRA) — approved Midodrine SmPC: https://www.medicines.org.uk/emc/product/12040/smpc
Midodrine is contraindicated in hypertension, particularly supine hypertension, and severe cardiovascular disease because of the risk of dangerous blood pressure elevation.
Do not use in hypertensive patients; monitor supine and standing blood pressure.
EMC-UK (MHRA) — approved Midodrine SmPC: https://www.medicines.org.uk/emc/product/12040/smpc
Midodrine should not be used in pregnancy unless strictly necessary because of a lack of safety data.
Use only if the benefit clearly outweighs the risk.
No sufficient data on excretion into breast milk; consider an alternative.
In women of childbearing age, rule out pregnancy before starting treatment.
EMC-UK (MHRA) — approved Midodrine SmPC: https://www.medicines.org.uk/emc/product/12040/smpc
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
Therapeutic effect is due to the active metabolite desglymidodrine, an alpha-1 agonist that increases arteriolar and venous tone, raising blood pressure standing, sitting and supine. It does not stimulate cardiac beta receptors; raises standing SBP ~15–30 mmHg 1 hour after 10 mg.
Prodrug: desglymidodrine activates alpha-1-adrenergic receptors of arteriolar and venous vasculature; diffuses poorly across the blood-brain barrier, with no central effects.
Rapidly absorbed: prodrug peaks at ~30 min and active metabolite at 1–2 hours; absolute bioavailability of 93% (measured as desglymidodrine); no significant protein binding.
Metabolized by deglycination to desglymidodrine in many tissues; both compounds are partly metabolized in the liver; not substrates of monoamine oxidase. Renal elimination of midodrine is insignificant; renal clearance of desglymidodrine is ~385 mL/min (~80% by active tubular secretion).
Half-life of midodrine ~25 min; half-life of desglymidodrine ~3–4 hours.
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
