Classifications: alpha1 agonist; vasopressor; Therapeutic: antihypotensive; vasopressor
Pregnancy Category: C
2.5 mg, 5 mg, 10 mg tablets
Vasopressor and alpha1 agonist. Activates the alpha-adrenergic receptors of the arteries and veins, resulting in increased vascular tone and elevation
in blood pressure.
Affects standing, sitting, and supine systolic and diastolic blood pressures. Indicated by an increase in 1-min standing
systolic BP and subjective feelings of clinical improvement.
Treatment of symptomatic orthostatic hypotension.
Severe organic heart disease; heart failure; acute kidney disease; urinary retention; pheochromocytoma; thyrotoxicosis;
MAOI therapy; persistent and excessive supine hypertension; pregnancy (category C).
Renal impairment, hepatic impairment; history of visual problems; diabetes with hypotension or visual disorders; lactation.
Safety and efficacy in children are not established.
Route & Dosage
Adult: PO 10 mg t.i.d. during the daytime hours, dosed not less than 3 h apart with last dose at least 4 h before bedtime (max: 20
- Do not give at bedtime or before napping (within 4 h of lying supine for any length of time).
- Give with caution in persons with pretreatment, supine systolic BP ≥170 mm
- Store at 15°30° C (59°86° F).
Adverse Effects (≥1%)Body as a Whole: Paresthesia,
chills, pain, facial flushing. CNS:
Confusion, nervousness, anxiety. CV: Hypertension. GI:
Dry mouth. Skin: Pruritus, piloerection,
rash. Urogenital: Dysuria, urinary retention, urinary frequency.
may antagonize effects of doxazosin, prazosin, terazosin;
may potentiate vasoconstrictive effects of ephedrine, phenylephrine, pseudoephedrine;
may cause hypertensive crisis with maois.
Rapidly from GI tract. Peak:
Midodrine 0.5 h; desglymidodrine 12 h. Metabolism:
Rapidly metabolized to desglymidodrine, the active metabolite
In urine. Half-Life:
Midodrine 25 min, desglymidodrine 34 h.
Assessment & Drug Effects
- Lab tests: Evaluate kidney and liver function prior to initiating therapy.
- Monitor supine and standing BP regularly. Stop drug if supine BP increases excessively; determine acceptable parameters.
- Monitor carefully effect of the drug in diabetics with orthostatic hypotension and those taking fludrocortisone acetate,
which may increase intraocular pressure.
Patient & Family Education
- Take last daily dose 4 h before bedtime.
- Report immediately to physician sensations associated with supine hypertension (e.g., pounding in ears, headache, blurred
vision, awareness of heart beating).
- Discontinue drug and report to physician if S&S of bradycardia develop (e.g., dizziness, pulse slowing, fainting).
- Do not take allergy drugs, cold preparations, or diet pills without consulting physician.