midodrine


Also found in: Dictionary, Wikipedia.
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.
References in periodicals archive ?
In 2018, the midodrine segment had a significant share.
Fludrocortisone may also be added to midodrine in patients with persistent OH symptoms.
Midregional pro-adrenomedullin as a predictor for therapeutic response to midodrine hydrochloride in children with postural orthostatic tachycardia syndrome.
For orthostatic hypotension, graduated compression stockings and midodrine are commonly used [5].
Nguyen, "Treatment of cirrhosis-associated hyponatremia with midodrine and octreotide," Frontiers in Medicine, vol.
Treatment of these disorders focuses on decreasing chyle production by dietary modifications (i.e., a low fat diet excluding long-chain triglycerides, TPN [25]), pharmacologic therapies (including octreotide [26], midodrine [27]), and/or surgical intervention (i.e., thoracic duct ligation) [1].
However, due to his significant orthostasis and need for further cisplatin therapy for curative intent, his treatment was expanded to pharmacological management with fludrocortisone and midodrine.
His initial pharmacologic management included furosemide, spironolactone, albumin, midodrine, pantoprazole, lactulose, rifaximin, and antibiotics for a possible pneumonia.
Severe orthostatic symptoms persisted despite maximal doses of midodrine and fludrocortisone and cerebrospinal fluid (CSF) analysis showed elevated protein of 109 mg/dl with normal cell count, glucose, and cytology.
These included carbidopa, ropinirole, midodrine, lamotrigine, duloxetine, nitrofurantoin, finasteride, and nortriptyline.
Bauman, "Orthostatic effects of midodrine versus L-NAME on cerebral blood flow and the renin-angiotensin-aldosterone system in tetraplegia," Archives of Physical Medicine and Rehabilitation, vol.
Frequently used vasoconstrictors include terlipressin, midodrine, and noradrenaline.