midodrine

ProAmatine is indicated for the treatment of symptomatic orthostatic hypotension (OH). Because ProAmatine can cause marked elevation of supine blood pressure (BP>200 mmHg systolic), it should be used in patients whose lives are considerably impaired despite standard clinical care, including non-pharmacologic treatment (such as support stockings), fluid expansion, and lifestyle alterations. The indication is based on ProAmatine’s effect on increases in 1-minute standing systolic blood pressure, a surrogate marker considered likely to correspond to a clinical benefit. At present, however, clinical benefits of ProAmatine, principally improved ability to perform life activities, have not been established. Further clinical trials are underway to verify and describe the clinical benefits of ProAmatine.

*This section republished from FDA prescribing information

What brand names are available for midodrine?

Orvaten, ProAmatine

Is midodrine available as a generic drug?

Yes

Do I need a prescription for midodrine?

Yes

The most common side effects of midodrine treatment are tingling, tickling, burning or prickling sensation, supine and sitting hypertension, numbness and itching which mainly affects the scalp area, goose bumps, chills, urinary urge, urinary retention, and urinary frequency.

Rare side effects associated with midodrine treatment are weakness, dry mouth, difficulty sleeping, anxiety, backache, canker sores, confusion, dizziness, dry skin, erythema, facial flushing, gas, upset stomach, heartburn, leg cramps, nausea, tiredness, and vision problems.

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.

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.

It is not known if midodrine is excreted in breast milk. Due to the lack of safety data, midodrine should be used cautiously in nursing mothers.

What preparations of midodrine are available?

Tablets: 2.5 mg, 5 mg, 10 mg

How should I keep midodrine stored?

Tablets should be stored at room temperature between 15 C to 30 C (59 F to 86 F).