midodrine hydrochloride

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Related to ProAmatine: Midodrine, Midodrine hydrochloride

midodrine hydrochloride

Amatine (CA), Apo-Midodrine (CA), Orvaten, ProAmatine

Pharmacologic class: Alpha1-adrenergic agonist

Therapeutic class: Antihypotensive, vasopressor

Pregnancy risk category C

FDA Box Warning

• Drug can markedly increase supine blood pressure, and should be used in patients whose lives are considerably impaired despite standard clinical care. Indication for its use in treating symptomatic orthostatic hypotension rests mainly on an increase in systolic pressure measured 1 minute after standing. Currently, drug's clinical benefits (mainly improved ability to perform activities of daily living) haven't been verified.


Forms active metabolite, desglymidodrine, an alpha1-adrenergic agonist that activates alpha-adrenergic receptors in arteriolar and venous vasculature. This effect increases vascular resistance and ultimately raises blood pressure.


Tablets: 2.5 mg, 5 mg

Indications and dosages

Symptomatic orthostatic hypotension

Adults: 10 mg P.O. t.i.d. during daytime hours with patient in upright position. Give first dose when patient arises in morning, second dose at midday, and third dose in late afternoon.

Dosage adjustment

• Renal impairment


• Severe coronary artery disease or organic heart disease

• Acute renal disease, urinary retention

• Pheochromocytoma

• Thyrotoxicosis

• Persistent, excessive supine hypertension


Use cautiously in:

• renal or hepatic impairment, diabetes mellitus, vision problems

• pregnant or breastfeeding patients.


• Don't give within 4 hours of bedtime.

Adverse reactions

CNS: paresthesia

CV: vasodilation, bradycardia, supine hypertension

GI: abdominal pain, dry mouth

GU: urinary retention, frequency, or urgency

Skin: rash, pruritus, piloerection

Other: chills, increased pain


Drug-drug. Alpha- and beta-adrenergic blockers, cardiac glycosides, steroids: increased risk of bradycardia, atrioventricular block

Alpha-adrenergic blockers, fludrocortisone: increased risk of supine hypertension

Patient monitoring

• Monitor supine and sitting blood pressures closely. Report marked rise in supine blood pressure.

• Stay alert for paresthesias.

• Monitor kidney function studies and fluid intake and output. Watch for urinary frequency, urgency, or retention.

Patient teaching

Instruct patient to take while in upright position.

• Tell patient to take first dose as soon as he arises for the day, second dose at midday, and third dose in late afternoon (before 6 P.M.). Stress that doses must be taken at least 3 hours apart. Advise patient not to take drug after dinner or within 4 hours of bedtime.

Instruct patient to promptly report symptoms of supine hypertension (pounding in ears, blurred vision, headache).

• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration, vision, and alertness.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs mentioned above.

References in periodicals archive ?
The 1996 approval of ProAmatine for the treatment of SOH was conditioned on the commitment to conduct two clinical trials to confirm the clinical benefit of midodrine.
Shire has little incentive to conduct new trials since the entry of generics in 2003 cut into ProAmatine sales, but the disease area does seem to be an attractive-if challenging--one for orphan drug developers.
The agency approved ProAmatine in 1996 based on promising early results in treating low blood pressure.
The FDA issued a letter to Shire and several makers of generic versions of ProAmatine proposing a withdrawal of the drug.
Last Monday the FDA issued a letter to Shire and several drugmakers that market generic versions of ProAmatine, proposing a withdrawal of the drug from the market.
23 September 2011 - UK specialty biopharmaceutical company Shire plc (LON:SHP) yesterday announced an update on the approval status and availability of ProAmatine (midodrine HCl), a medicine approved for the treatment of symptomatic orthostatic hypotension (SOH).
Currently ProAmatine remains available to patients who critically need the medicine and who would be left without alternative treatments if it is withdrawn from the market.
ProAmatine was approved in the USA in 1996 with a post-approval commitment to conduct two clinical trials to verify the clinical effect of midodrine.
The agency will continue to allow access to ProAmatine, also known as midodrine, until the necessary data is collected and the legal issues get sorted out.
It had approved ProAmatine in 1996 based on promising early results in treating low blood pressure.