midodrine
Midodrine is used to treat symptoms of orthostatic hypotension (low blood pressure that happens when there's a change from a lying down or sitting position to a standing position). It belongs to a drug class that works by squeezing your blood vessels in order to raise your blood pressure. You should only take midodrine while you're upright because it can raise your blood pressure to dangerous levels if you take it while lying down. Midodrine can cause side effects like tingling or pricking feeling and goosebumps. Midodrine is available as a generic; there's no brand-name version of this medication.
What is Midodrine?
What is Midodrine used for?
Symptomatic orthostatic hypotension
How Midodrine works
Midodrine is an alpha-1 adrenergic receptor agonist. It raises blood pressure by tightening the blood vessels in the body.
Drug Facts
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What are the side effects of Midodrine?
Common Side Effects
- Tingling or pricking feeling (18%)
- Goosebumps (13%)
- Painful urination (13%)
- Itchy skin (12%)
- High blood pressure when lying down (7%)
- Chills (5%)
- Pain (5%)
- Rash (2%)
Other Side Effects
- Headache
- Feeling of pressure or fullness in the head
- Flushing in the face
- Confusion or abnormal thoughts
- Dry mouth
- Nervousness
- Anxiety
- Rash
Serious Side Effects
- High blood pressure (more than 200 mmHg) when lying down: changes in heartbeat, pounding in the ears, headache, blurred vision
Source:Â DailyMed
More on Midodrine side effects
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Blurred vision
cardiac awareness
headache
pounding in the ears
Rare
Fainting
increased dizziness
slow pulse
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Burning, itching, or prickling of the scalp
chills
goosebumps
urinary frequency, retention, or urgency
Less common
Anxiety or nervousness
confusion
flushing
headache or feeling of pressure in the head
skin rash
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Midodrine
Pros
Older adults don't need to have their dose adjusted.
Raises blood pressure within an hour after taking
Available as a lower-cost generic
Cons
Must take the medication while upright
Has to be taken multiple times a day
Not studied in children
Pharmacist tips for Midodrine
Take midodrine during the day when you're able to sit and stand up. Don't take it while lying down. Doing so can cause your blood pressure to get dangerously high.
Don't take midodrine too close to bedtime. It's best to take your last dose before dinner, at least 4 hours before bedtime. This will help make sure your blood pressure doesn't get too high when you lie down to sleep.
Let your provider know if you experience symptoms of high blood pressure when lying down, such as changes in your heartbeat, pounding in the ears, headache, or blurred vision. Stop taking midodrine as soon as possible if these symptoms won't go away.
Check and record your blood pressure regularly when you're lying down, sitting, and standing, especially when you first start midodrine. Share your logbook entries with your healthcare provider. If your blood pressure is much higher when you're lying down or sitting than when you're standing, you might need to stop this medication.
Let your provider know if you're taking midodrine together with other medications that can raise blood pressure, such as phenylephrine, pseudoephedrine, or dihydroergotamine. Other medications include certain over-the-counter cold medications and weight loss medications. If you're not sure, check with your pharmacist or provider.
Frequently asked questions about Midodrine
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What are the risks and warnings for Midodrine?
Midodrine can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Significant rise in blood pressure when lying down
Don't take midodrine while you're lying down or getting ready to lie down. Midodrine can raise your blood pressure to dangerous levels (above 200 mmHg) if you're lying down. Because of this risk, you should only use midodrine if your everyday life is affected by your orthostatic hypotension and if other methods (like support stockings, fluids, or lifestyle changes) aren't enough to help. Let your provider know if you experience symptoms of very high blood pressure when lying down after taking midodrine, such as changes in your heartbeat, pounding in the ears, headache, or blurred vision. Stop this medication right away if these symptoms won't go away.
Slow heart rate
Midodrine might slow down your heart rate. Talk with your provider before starting midodrine if you're taking other medications that also lower your heart rate, such as digoxin (Lanoxin), beta blockers, or certain antidepressants. Let your provider know if you experience symptoms of a slow pulse, dizziness, feeling of wanting to faint, or changes in your heartbeat.
Taking midodrine while having other health problems
Risk factors: Kidney problems | Liver problems | Diabetes | Having eye problems while also taking fludrocortisone
Because midodrine tightens blood vessels, this medication might make certain health problems worse. Midodrine acts on the blood vessels at the bladder neck, so it can make it worse for people who already have difficulty urinating. In addition, midodrine can affect the eyes, especially in people with diabetes. You also might be at risk if you have a history of eye problems and are also taking fludrocortisone (a medication that's known to cause high eye pressure and glaucoma).
Midodrine gets processed through the liver and is cleared by the body through the kidneys. If your liver or kidneys aren't working properly, the medication might build up in the body, which puts you at risk for side effects. If you have liver problems, your provider might have to follow up with you more often. And if you have kidney problems, your provider might have you start on a lower dose of midodrine. This helps lower your risk for side effects.
Midodrine dosage forms
Typical dosing for Midodrine
The typical dose is 10 mg by mouth 3 times daily.
Your dose might differ if you have kidney problems.
Interactions between Midodrine and other drugs
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Dihydroergotamine
- Tranylcypromine
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Deslanoside
- Digitoxin
- Droxidopa
- Ephedrine
- Furazolidone
- Iobenguane I 123
- Iobenguane I 131
- Iproniazid
- Isocarboxazid
- Levothyroxine
- Linezolid
- Liothyronine
- Methylene Blue
- Moclobemide
- Nialamide
- Phenelzine
- Phenylephrine
- Phenylpropanolamine
- Procarbazine
- Pseudoephedrine
- Rasagiline
- Safinamide
- Selegiline
- Thyroid
- Toloxatone
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
How much does Midodrine cost?
Midodrine contraindications
Severe heart conditions
Sudden kidney problems
Unable to empty bladder completely when urinating (urinary retention)
Rare tumor in an adrenal gland tissue called pheochromocytoma
High levels of thyroid hormone (thyrotoxicosis)
High blood pressure that occurs often when lying down
What are alternatives to Midodrine?
Addison's disease (adrenal insufficiency)
Congenital adrenal hyperplasia (a genetic condition that affects hormone production)
Treatment of low blood pressure in people with a nervous system problem called neurogenic orthostatic hypotension (nOH) that's caused by certain medical conditions (e.g., multiple system atrophy, pure autonomic failure, Parkinson's disease)
Midodrine images
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References
Best studies we foundAlembic Pharmaceuticals Limited. (2023). MIDODRINE HYDROCHLORIDE tablet [package insert]. DailyMed.
Blick, C., et al. (2022). Thyrotoxicosis. StatPearls.
Dean, J. S., II., et al. (2022). Alpha-1 receptor agonists. StatPearls.
Dhruva, S. S., et al. (2010). Accelerated approval and possible withdrawal of midodrine. Journal of the American Medical Association.
Genetic and Rare Diseases Information Center. (2023). Dopamine beta-hydroxylase deficiency. National Center for Advancing Translational Sciences.
Genetic and Rare Diseases Information Center. (2023). Pure autonomic failure. National Center for Advancing Translational Sciences.
National Cancer Institute. (2020). Pheochromocytoma.
National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.). Urinary retention.
National Institute of Neurological Disorders and Stroke. (2023). Multiple system atrophy.
Vaidyanathan, S. (2007). Midodrine: insidious development of urologic adverse effects in patients with spinal cord injury: a report of 2 cases. Advances in Therapy.
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