midodrine


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Related to midodrine: fludrocortisone, Florinef

midodrine

 [mi´do-drēn″]
a vasopressor used as the hydrochloride salt in treatment of orthostatic hypotension; administered orally.

midodrine

(mye-doe-dreen) ,

ProAmatine

(trade name)

Classification

Therapeutic: vasopressors
Pregnancy Category: C

Indications

Symptomatic management of refractory orthostatic hypotension in patients whose livers are impaired.Urinary incontinence.

Action

Activation of alpha-1–adrenergic receptors in arteries and veins.

Therapeutic effects

Increase in vascular tone and BP.

Pharmacokinetics

Absorption: 93% absorbed following oral administration; rapidly converted to desglymidodrine, the active metabolite.
Distribution: Desglymidodrine crosses the blood-brain barrier poorly.
Metabolism and Excretion: Desglymidodrine is 80% excreted by the kidneys.
Half-life: Midodrine—25 min; desglymidodrine—3–4 hr.

Time/action profile (blood levels of active metabolite)

ROUTEONSETPEAKDURATION
POrapid 1–2 hr2–3 hr

Contraindications/Precautions

Contraindicated in: Urinary retention; Severe organic heart disease; Acute renal disease; Persistent/excessive supine hypertension; Pheochromocytoma; Thyrotoxicosis.
Use Cautiously in: History of hypertensionRenal impairment (↓ initial dose); Hepatic impairment; Diabetes mellitus, visual problems, concurrent fludrocortisone (↑ risk of visual disturbances); Obstetric / Pediatric: Pregnancy, lactation or children (safety not established).

Adverse Reactions/Side Effects

Central nervous system

  • anxiety
  • confusion
  • head pressure/fullness
  • headache
  • nervousness

Cardiovascular

  • supine hypertension (most frequent)
  • bradycardia

Genitourinary

  • urinary urge/retention/frequency (most frequent)
  • dysuria (most frequent)

Dermatologic

  • facial flushing
  • piloerection (most frequent)
  • pruritus (most frequent)
  • rash

Neurologic

  • paresthesia (most frequent)

Miscellaneous

  • chills
  • pain

Interactions

Drug-Drug interaction

↑ risk of bradycardia with digoxin, beta blockers, and antipsychotics.Concurrent use with other alpha-adrenergic agonists including phenylephrine, ephedrine, pseudoephedrine, and dihydroergotamine may result in ↑ pressor effect.Effects may be ↓ by alpha-adrenergic blockers including prazosin, terazosin, and doxazosin.↑ Effects of fludrocortisone (↓ initial dose of fludrocortisone or ↓ salt intake prior to midodrine).

Route/Dosage

Oral (Adults) Orthostatic hypotension—10 mg three times daily; urinary incontinence—2.5–5 mg two to three times daily.

Renal Impairment

Oral (Adults) 2.5 mg three times daily.

Availability (generic available)

Tablets: 2.5 mg, 5 mg, 10 mg

Nursing implications

Nursing assessment

  • Monitor supine and sitting BP prior to and during therapy.
  • Assess pattern of urinary output prior to and during treatment for incontinence.
  • Lab Test Considerations: Monitor renal and hepatic function prior to and periodically during therapy.

Potential Nursing Diagnoses

Decreased cardiac output (Indications)
Risk for injury (Indications)

Implementation

  • Oral: Administer 3 times daily at 3–4 hr intervals. Do not administer after last meal or within 4 hr of bedtime.

Patient/Family Teaching

  • Instruct patient to take midodrine as directed. First dose should be taken on or shortly after arising, second dose at midday, and third dose should be taken before evening meal and at least 4 hr before bedtime. Take missed doses as soon as remembered unless almost time for next dose; do not double doses.
  • Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.

Evaluation/Desired Outcomes

  • Decrease in signs and symptoms of orthostatic hypotension.
  • Decrease in the incidence of urinary incontinence.

midodrine

/mi·do·drine/ (mi´do-drēn″) a vasopressor used as the hydrochloride salt in the treatment of orthostatic hypotension.

midodrine

a vasopressor.
indication It is used to treat orthostatic hypotension.
contraindications Factors that prohibit its use include known hypersensitivity to midodrine, severe organic heart disease, acute renal disease, urinary retention, pheochromocytoma, thyrotoxicosis, and persistent or excessive supine hypertension.
adverse effects Adverse effects include drowsiness, restlessness, headache, chills, nausea, anorexia, dry mouth, blurred vision, pruritus, piloerection, rash, urinary urgency, and supine hypertension. Common side effects are paresthesia and pain.
References in periodicals archive ?
2007) were able to show that the application of the relatively long-acting sympathomimetics midodrine and etilefrine lead to increased attentional performance.
Food and Drug Administration (FDA) to conduct two additional clinical trials to verify and describe the clinical benefit of midodrine HCI.
Midodrine received accelerated approval as ProAmatine in 1996 based on the surrogate end point of increase in 1-minute standing systolic blood pressure.
In the United States, neither ornipressin nor terlipressin is available, and the most popular intervention for hepatorenal syndrome is to expand blood volume using intravenous albumin, then to administer midodrine and octreotide to regulate vascular contraction (Angeli et al.
Twenty-four hours after patients started showing improvement, they were weaned off this aggressive intravenous regimen and onto oral therapy with fludrocortisone, midodrine, and salt tablets.
This year, NASA plans to see whether taking midodrine before their spacecraft lands can help astronauts reduce subsequent orthostatic intolerance.
Shire, the NDA holder for ProAmatine, remains committed to ensuring midodrine remains available for patients who critically need this medicine and who would be left without alternative treatments should it be withdrawn from the market.
Notably, the FDA clarified that the FDA's prior announcement related to midodrine "did not represent the actual withdrawal of the medication from the market.
This result is in line with studies demonstrating beneficial effects of the blood pressure enhancing sympathomimetics midodrine and etilefrine on cognitive function in hypotension (Duschek et al.
If they do not work, then administration of drugs such as beta blockers, fiudrocortisone serotonin reuptake inhibitors and midodrine can be tried.
Some patients have temporarily been treated with dialysis or a combination of midodrine (selective [alpha]-1 adrenergic agonist) and octreotide (somatostatin analog) as a bridge to transplant.