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Related to midodrine: fludrocortisone, Florinef
Pregnancy Category: C
Symptomatic management of refractory orthostatic hypotension in patients whose livers are impaired.Urinary incontinence.
Activation of alpha-1–adrenergic receptors in arteries and veins.
Increase in vascular tone and BP.
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)
|PO||rapid||1–2 hr||2–3 hr|
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
- head pressure/fullness
- supine hypertension (most frequent)
- urinary urge/retention/frequency (most frequent)
- dysuria (most frequent)
- facial flushing
- piloerection (most frequent)
- pruritus (most frequent)
- paresthesia (most frequent)
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).
Oral (Adults) Orthostatic hypotension—10 mg three times daily; urinary incontinence—2.5–5 mg two to three times daily.
Renal ImpairmentOral (Adults) 2.5 mg three times daily.
Availability (generic available)
Tablets: 2.5 mg, 5 mg, 10 mg
- 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 DiagnosesDecreased cardiac output (Indications)
Risk for injury (Indications)
- Oral: Administer 3 times daily at 3–4 hr intervals. Do not administer after last meal or within 4 hr of bedtime.
- 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.
- 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.
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.