7 Midodrine Side Effects to Be Aware Of

If you’ve ever stood up too quickly after lying down and felt your head start spinning, then you’re familiar with orthostatic hypotension. It happens when there’s a drop in your blood pressure when you sit up or stand after lying down. You may feel dizzy or lightheaded when this happens, but in some cases it can also cause you to pass out.

Orthostatic hypotension can happen to anyone now and then. But if it happens to you often, your healthcare provider may prescribe a medication called midodrine (Proamatine) to treat it.

Midodrine is an alpha-1 agonist medication that works by tightening your blood vessels, which raises your blood pressure. This can help prevent your blood pressure from dropping when you change positions. But, like all medications, it comes with side effects to consider.

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Midodrine side effects at a glance

Below is a list of common and rare midodrine side effects reported by people taking it in clinical studies.

Common side effects (reported by around 5% of people or more)

• Tingling or numbness in the hands, feet, or scalp 

• Goose bumps

• Pain when peeing

• Needing to pee more often

• Itchy skin or scalp 

• High blood pressure when lying down

• Chills

• Pain

Rare side effects (reported by less than 5% of people):

• Rash

• Flushed face

• Confusion

• Dry mouth

• Anxiety

• Dizziness

• Insomnia

• Slow heartbeat

Let’s take a closer look at seven midodrine side effects you should be aware of.

1. Tingling or numbness

A tingling or numb sensation on your skin (paresthesia) is one of the most common midodrine side effects. Almost 1 in 5 people experience it. It happens because midodrine narrows the blood vessels in the hair follicles of your skin.

Tingling and numbness can be unpleasant, but they’re usually not harmful. If your symptoms are severe or preventing you from walking or using your hands the way you normally do, let your healthcare provider know. They may want to lower your midodrine dose or have you try a different medication.

2. Chills and goose bumps

Midodrine can also cause chills and goose bumps. This is due to the effect of midodrine on your hair follicles. Tightening the blood vessels in hair follicles can make your hair stand up, forming goose bumps. And since less blood is flowing at the surface of your skin, it’s also common to feel chills when this happens.

This side effect should go away on its own. In the meantime, try cozying up with a warm hat, blanket, or heating pad. A hot shower or warm beverage might also help make you more comfortable. 

Let your provider know if chills are bothersome for you. They may be able to change your midodrine dosage to help ease these symptoms. If you have chills along with other symptoms, such as a fever, seek medical care. This could be a sign of an infection.

3. Trouble peeing

As mentioned, midodrine works by tightening your blood vessels. Sometimes, it can have the same effect on your bladder, too. This might make it harder for you to fully empty your bladder when you pee (urinary retention). It can also make you feel like you need to pee more often or have pain when you’re peeing. 

This side effect isn’t always an issue as long as you’re still able to relieve your bladder when you need to. But let your provider know if you’re peeing less than usual or have pain when peeing. These could be signs of a more severe bladder issue or a urinary tract infection.   

4. Itchy skin and scalp

Taking midodrine can make your skin feel itchy. This includes itchiness on your scalp as well. Itchiness is related to the tingling feeling and goose bumps that can happen when midodrine tightens the blood vessels in your skin and hair follicles. But it seems to happen less often than other skin-related side effects.

Hydration may help with itchy skin. You can also use a moisturizing cream or lotion several times throughout the day. And be sure to drink plenty of water. Talk to your provider if the  itching is severe or doesn’t go away. They may suggest a lower dose of midodrine. Or a different medication may be a better option for you.

5. Flushed face

A red or flushed face is another possible midodrine side effect, but it’s not very common. You may also notice a feeling of fullness or pressure in your head from time to time. A cool compress on your face or the back of your neck may help lessen flushing. But these symptoms should go away on their own in most cases.

Let your provider know if you’re experiencing these symptoms often, or if they aren’t going away. It could be a sign your blood pressure is too high — more on that next.

6. High blood pressure

The most serious midodrine side effect is high blood pressure when you’re lying down (supine hypertension). In fact, midodrine has a boxed warning, the FDA’s most serious warning, about this side effect. If left untreated, this type of high blood pressure can lead to serious health problems. If you already have high blood pressure, midodrine isn’t recommended, as it may worsen your condition.

To prevent high blood pressure when lying down, you should only take midodrine while you’re awake. And it’s best to avoid naps or activities that require you to lie down after taking it. Your last dose of midodrine should be at least 3 to 4 hours before bedtime to prevent this side effect while you sleep.

Let your provider know if you experience any of the following high blood pressure symptoms when lying down, such as: 

• Feeling a stronger heartbeat than usual

• Pounding in your ears

• Headache 

• Blurred vision

A lower midodrine dosage may help resolve high blood pressure. But if it doesn’t go away, you’ll likely need to stop taking midodrine.

7. Slow heart rate

Another rare midodrine side effect is a slow heart rate, or bradycardia. You may not notice this side effect if it’s mild. But if your heart rate slows too much, you may feel dizzy or faint.

Symptoms of a slow heart rate may be similar to your orthostatic hypotension symptoms. But instead of only happening when you sit up or stand, slow heart rate symptoms are more consistent and don’t go away.

Be sure to let your provider know if your heartbeat feels slower than usual or if you’re feeling dizzy or faint after taking midodrine. If your symptoms seem severe at any point, seek emergency care.

When should I contact my healthcare provider about midodrine side effects?

It’s a good idea to let your healthcare provider know about any midodrine side effects you’re having — especially when you first start taking it. They may be able to adjust your dosage to help manage any side effects that appear.

If you notice any signs of high blood pressure when lying down, a slow heart rate, or trouble peeing, let your provider know right away. And if your symptoms feel severe, don’t hesitate to seek emergency care.

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Written by:

Justin DeFlorian, PharmD, BCPS

Justin DeFlorian, PharmD, BCPS, is a board-certified clinical pharmacist. He received his Doctor of Pharmacy degree from the University of Wisconsin-Madison.

Edited by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

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