midodrine (Orvaten, ProAmatine) (cont.)

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DOSING: Orthostatic hypotension: The recommended dose is 2.5 to 10 mg 3 times daily during daytime hours while the patient is upright and participating in activities of daily living. The usual dose is 10 mg 3 times daily. A 4-hour interval should be observed shortly before or upon arising in the morning, midday, and late afternoon (no later than 6 PM). Midodrine should not be given more frequently than every 3 hours. The maximum daily dose is 40 mg. Midodrine should not be given after the evening meal or less than 4 hours before bedtime. Midodrine should only be continued in patients who respond during initial treatment.

DRUG INTERACTIONS: Midodrine may cause a decrease in the heart rate. Caution should be used when midodrine is given in other medications that may also reduce the heart rate such as cardiac glycosides, tricyclic antidepressants, beta blockers, and other agents.

Medications which have similar stimulatory effects on alpha-adrenergic receptors may enhance the pressor effects of midodrine. Examples of such medications include phenylephrine, pseudoephedrine, ephedrine, phenylpropanolamine, dihydroergotamine, and other agents that cause vasoconstriction.

Alpha-adrenergic blocking agents such as prazosin (Minipress), terazosin (Hytrin), and doxazosin (Cardura) may antagonize or cancel out the effects of midodrine therapy.

Midodrine may compete with drugs such as metformin (Glucophage), cimetidine (Tagamet), ranitidine (Zantac), procainamide (Pronestyl), triamterene (Dyrenium), flecainide (Tambocor), and quinidine for elimination by renal tubular secretion (clearance through the kidneys). Caution should be used if midodrine must be used with any of these agents.

PREGNANCY: Midodrine has not been adequately evaluated in pregnant women. Due to the lack of conclusive safety data, midodrine should be used in pregnancy only if the potential benefit justifies the potential risk to the fetus. Midodrine is classified as FDA pregnancy risk category C (Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks).

Medically Reviewed by a Doctor on 11/11/2014

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