Dosing & Uses
Dosage Forms & Strengths
tablet
- 2.5mg
- 5mg
- 10mg
Symptomatic Orthostatic Hypotension
2.5-10 mg PO q8hr
Usual dose: 10 mg PO q8hr
Doses greater than 30 mg/day have not been studied; should not exceed 40 mg/day
Stress Incontinence (Off-label)
2.5-5 mg PO q8-12hr
Dosing Modifications
Renal impairment: 2.5 mg PO q8hr; increase as tolerated
Safety & efficacy not established
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (5)
- isocarboxazid
isocarboxazid increases effects of midodrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- linezolid
linezolid increases effects of midodrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- phenelzine
phenelzine increases effects of midodrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- selegiline transdermal
selegiline transdermal increases effects of midodrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- tranylcypromine
tranylcypromine increases effects of midodrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
Serious - Use Alternative (28)
- amitriptyline
amitriptyline, midodrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- amoxapine
amoxapine, midodrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- cabergoline
cabergoline, midodrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- clomipramine
clomipramine, midodrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- desflurane
desflurane increases toxicity of midodrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- desipramine
desipramine, midodrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- dihydroergotamine
dihydroergotamine, midodrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- dihydroergotamine intranasal
dihydroergotamine intranasal, midodrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- doxapram
doxapram increases effects of midodrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.
- doxepin
doxepin, midodrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- ergoloid mesylates
ergoloid mesylates, midodrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- ergotamine
ergotamine, midodrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- ether
ether increases toxicity of midodrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- imipramine
imipramine, midodrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- isoflurane
isoflurane increases toxicity of midodrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- lofepramine
lofepramine, midodrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- maprotiline
maprotiline, midodrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- methoxyflurane
methoxyflurane increases toxicity of midodrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- methylergonovine
methylergonovine, midodrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- nortriptyline
nortriptyline, midodrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- procarbazine
procarbazine increases effects of midodrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of acute hypertensive episode.
- protriptyline
protriptyline, midodrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- rasagiline
rasagiline increases effects of midodrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Midodrine should not be given concurrently with monoamine oxidase inhibitors (MAOIs). Risk of acute hypertensive episode.
- selegiline
selegiline increases effects of midodrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Midodrine should not be given concurrently with monoamine oxidase inhibitors (MAOIs). Risk of acute hypertensive episode.
- sevoflurane
sevoflurane increases toxicity of midodrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- trazodone
trazodone, midodrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- trimipramine
trimipramine, midodrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- yohimbe
yohimbe, midodrine. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
Monitor Closely (167)
- albuterol
albuterol and midodrine both decrease sedation. Use Caution/Monitor.
albuterol and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - alfentanil
alfentanil increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- alprazolam
alprazolam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- amiodarone
amiodarone will increase the level or effect of midodrine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
- amitriptyline
amitriptyline increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- amobarbital
amobarbital increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- amoxapine
amoxapine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- arformoterol
arformoterol and midodrine both decrease sedation. Use Caution/Monitor.
arformoterol and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - aripiprazole
aripiprazole increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- armodafinil
armodafinil and midodrine both decrease sedation. Use Caution/Monitor.
- atomoxetine
atomoxetine, midodrine. Other (see comment). Use Caution/Monitor. Comment: Due to the potential for increases in blood pressure and heart rate, atomoxetine should be used cautiously with vasopressors such as midodrine.
- azelastine
azelastine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- belladonna and opium
belladonna and opium increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- benperidol
benperidol increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- benzphetamine
benzphetamine and midodrine both decrease sedation. Use Caution/Monitor.
benzphetamine and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - bromocriptine
bromocriptine, midodrine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Hypertension, V tach.
- brompheniramine
brompheniramine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- buprenorphine buccal
buprenorphine buccal increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- butabarbital
butabarbital increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- butalbital
butalbital increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- butorphanol
butorphanol increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- caffeine
caffeine and midodrine both decrease sedation. Use Caution/Monitor.
- carbinoxamine
carbinoxamine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- chloral hydrate
chloral hydrate increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- chlordiazepoxide
chlordiazepoxide increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- chlorpheniramine
chlorpheniramine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- chlorpromazine
chlorpromazine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
chlorpromazine, midodrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. - cimetidine
cimetidine will increase the level or effect of midodrine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
- cinnarizine
cinnarizine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- clemastine
clemastine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- clomipramine
clomipramine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- clonazepam
clonazepam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- clorazepate
clorazepate increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- clozapine
clozapine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- codeine
codeine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- cyclizine
cyclizine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- cyproheptadine
cyproheptadine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- desipramine
desipramine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dexchlorpheniramine
dexchlorpheniramine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dexfenfluramine
dexfenfluramine and midodrine both decrease sedation. Use Caution/Monitor.
dexfenfluramine and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - dexmedetomidine
dexmedetomidine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dexmethylphenidate
dexmethylphenidate and midodrine both decrease sedation. Use Caution/Monitor.
dexmethylphenidate and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - dextroamphetamine
dextroamphetamine and midodrine both decrease sedation. Use Caution/Monitor.
dextroamphetamine and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - dextromoramide
dextromoramide increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- diamorphine
diamorphine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- diazepam
diazepam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- diethylpropion
diethylpropion and midodrine both decrease sedation. Use Caution/Monitor.
diethylpropion and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - difenoxin hcl
difenoxin hcl increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- digoxin
digoxin will increase the level or effect of midodrine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
- dimenhydrinate
dimenhydrinate increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- diphenhydramine
diphenhydramine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- diphenoxylate hcl
diphenoxylate hcl increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dipipanone
dipipanone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dobutamine
dobutamine and midodrine both decrease sedation. Use Caution/Monitor.
dobutamine and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - dofetilide
dofetilide will increase the level or effect of midodrine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
- dopamine
dopamine and midodrine both decrease sedation. Use Caution/Monitor.
dopamine and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - dopexamine
dopexamine and midodrine both decrease sedation. Use Caution/Monitor.
dopexamine and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - doxepin
doxepin increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- droperidol
droperidol increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- droxidopa
midodrine and droxidopa both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. May increase risk for supine hypertension
- ephedrine
ephedrine and midodrine both decrease sedation. Use Caution/Monitor.
ephedrine and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
ephedrine, midodrine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. - epinephrine
epinephrine and midodrine both decrease sedation. Use Caution/Monitor.
epinephrine and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - epinephrine racemic
epinephrine racemic and midodrine both decrease sedation. Use Caution/Monitor.
epinephrine racemic and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - estazolam
estazolam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ethanol
ethanol increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- fenfluramine
fenfluramine and midodrine both decrease sedation. Use Caution/Monitor.
fenfluramine and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - fluphenazine
fluphenazine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
fluphenazine, midodrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. - flurazepam
flurazepam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- formoterol
formoterol and midodrine both decrease sedation. Use Caution/Monitor.
formoterol and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - haloperidol
haloperidol increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- hydralazine
hydralazine, midodrine. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Sympathomimetics can antagonize the activity of some antihypertensive agents.
- hydromorphone
hydromorphone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- hydroxyzine
hydroxyzine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- iloperidone
iloperidone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- imipramine
imipramine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- isoproterenol
isoproterenol and midodrine both decrease sedation. Use Caution/Monitor.
isoproterenol and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - ketotifen, ophthalmic
ketotifen, ophthalmic increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- levalbuterol
levalbuterol and midodrine both decrease sedation. Use Caution/Monitor.
levalbuterol and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - levorphanol
levorphanol increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lisdexamfetamine
lisdexamfetamine and midodrine both decrease sedation. Use Caution/Monitor.
lisdexamfetamine and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - lofepramine
lofepramine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lofexidine
lofexidine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- loprazolam
loprazolam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lorazepam
lorazepam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lormetazepam
lormetazepam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- loxapine
loxapine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- loxapine inhaled
loxapine inhaled increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- maprotiline
maprotiline increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- marijuana
marijuana increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- melatonin
melatonin increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- meperidine
meperidine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- meprobamate
meprobamate increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- metaproterenol
metaproterenol and midodrine both decrease sedation. Use Caution/Monitor.
metaproterenol and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - metaxalone
metaxalone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methadone
methadone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methamphetamine
methamphetamine and midodrine both decrease sedation. Use Caution/Monitor.
methamphetamine and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - methyldopa
methyldopa increases effects of midodrine by unknown mechanism. Use Caution/Monitor.
- methylenedioxymethamphetamine
methylenedioxymethamphetamine and midodrine both decrease sedation. Use Caution/Monitor.
methylenedioxymethamphetamine and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - midazolam
midazolam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- mirtazapine
mirtazapine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- modafinil
modafinil and midodrine both decrease sedation. Use Caution/Monitor.
- morphine
morphine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- motherwort
motherwort increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- moxonidine
moxonidine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nabilone
nabilone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nalbuphine
nalbuphine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- norepinephrine
norepinephrine and midodrine both decrease sedation. Use Caution/Monitor.
norepinephrine and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - nortriptyline
nortriptyline increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- olanzapine
olanzapine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- opium tincture
opium tincture increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oxazepam
oxazepam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oxycodone
oxycodone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oxymetazoline topical
oxymetazoline topical and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- oxymorphone
oxymorphone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oxytocin
oxytocin increases effects of midodrine by pharmacodynamic synergism. Use Caution/Monitor.
- paliperidone
paliperidone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- papaveretum
papaveretum increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pentazocine
pentazocine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pentobarbital
pentobarbital increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- perphenazine
perphenazine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
perphenazine, midodrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. - phendimetrazine
midodrine and phendimetrazine both decrease sedation. Use Caution/Monitor.
midodrine and phendimetrazine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - phenobarbital
phenobarbital increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phentermine
phentermine and midodrine both decrease sedation. Use Caution/Monitor.
midodrine and phentermine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - phenylephrine
midodrine and phenylephrine both decrease sedation. Use Caution/Monitor.
midodrine and phenylephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - phenylephrine PO
midodrine and phenylephrine PO both decrease sedation. Use Caution/Monitor.
midodrine and phenylephrine PO both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - pholcodine
pholcodine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pimozide
pimozide increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pirbuterol
pirbuterol and midodrine both decrease sedation. Use Caution/Monitor.
pirbuterol and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - primidone
primidone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- procainamide
midodrine will increase the level or effect of procainamide by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
- prochlorperazine
prochlorperazine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
prochlorperazine, midodrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. - promazine
promazine, midodrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.
- promethazine
promethazine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
promethazine, midodrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. - propofol
propofol increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- propylhexedrine
midodrine and propylhexedrine both decrease sedation. Use Caution/Monitor.
midodrine and propylhexedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - protriptyline
protriptyline increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pseudoephedrine
midodrine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- quazepam
quazepam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- quetiapine
quetiapine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- quinidine
quinidine will increase the level or effect of midodrine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
- risperidone
risperidone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- safinamide
midodrine and safinamide both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Monitor patients for hypertension if safinamide is prescribed concomitantly with prescription or nonprescription sympathomimetics, including nasal, oral, or ophthalmic decongestants and cold remedies.
- salmeterol
salmeterol and midodrine both decrease sedation. Use Caution/Monitor.
salmeterol and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - scullcap
scullcap increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- secobarbital
secobarbital increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- serdexmethylphenidate/dexmethylphenidate
serdexmethylphenidate/dexmethylphenidate and midodrine both decrease sedation. Use Caution/Monitor.
serdexmethylphenidate/dexmethylphenidate and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - shepherd's purse
shepherd's purse increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- solriamfetol
midodrine and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- sufentanil
sufentanil increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- tapentadol
tapentadol increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- temazepam
temazepam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- tenofovir DF
tenofovir DF increases levels of midodrine by decreasing renal clearance. Use Caution/Monitor. Potential for increased toxicity. .
- terbutaline
terbutaline and midodrine both decrease sedation. Use Caution/Monitor.
terbutaline and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - thioridazine
thioridazine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
thioridazine, midodrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. - thiothixene
thiothixene increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- topiramate
topiramate increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- tramadol
tramadol increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- trazodone
trazodone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- triazolam
triazolam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- triclofos
triclofos increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- trifluoperazine
trifluoperazine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
trifluoperazine, midodrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. - trimipramine
trimipramine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- triprolidine
triprolidine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- xylometazoline
midodrine and xylometazoline both decrease sedation. Use Caution/Monitor.
midodrine and xylometazoline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - yohimbine
yohimbine and midodrine both decrease sedation. Use Caution/Monitor.
midodrine and yohimbine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - ziconotide
ziconotide increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ziprasidone
ziprasidone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
Minor (13)
- desmopressin
desmopressin increases effects of midodrine by pharmacodynamic synergism. Minor/Significance Unknown.
- eucalyptus
eucalyptus increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.
- hydrochlorothiazide
hydrochlorothiazide will increase the level or effect of midodrine by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- memantine
memantine will increase the level or effect of midodrine by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- metformin
metformin will increase the level or effect of midodrine by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- methyclothiazide
methyclothiazide will increase the level or effect of midodrine by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- ofloxacin
midodrine will increase the level or effect of ofloxacin by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- quinine
midodrine will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- sage
sage increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.
- sulfamethoxazole
sulfamethoxazole will increase the level or effect of midodrine by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- triamterene
midodrine will increase the level or effect of triamterene by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- trimethoprim
midodrine will increase the level or effect of trimethoprim by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- verapamil
midodrine will increase the level or effect of verapamil by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.
Adverse Effects
>10%
Paresthesia (18%)
Piloerection (13%)
Pruritus (13%)
Supine hypertension (7-13%)
Urinary retention or urgency (up to 13%)
1-10%
Chills (5%)
Pain, including abdominal pain (5%)
Rash (2%)
<1%
Anxiety
Canker sore
Confusion
Dizziness
Dry skin
Erythema multiforme
Facial flushing
Flushing
Headache
Hyperesthesia
Insomnia
Intracranial pressure increased
Nausea
Somnolence
Weakness
Xerostomia
Warnings
Black Box Warnings
May cause marked elevation of supine blood pressure; reserve use for patients whose lives are considerably impaired despite standard clinical care for orthostatic hypotension
Contraindications
Severe organic heart disease, supine HTN, acute renal disease, urinary retention, pheochromocytoma, thyrotoxicosis
Cautions
May slow heart rate primarily due to vagal reflex; use caution when administering concomitantly with negative chronotropes, including digoxin, beta blockers, or other agents that decrease heart rate; discontinue use if signs or symptoms of bradycardia occur
Risk of hypertension increases with concomitant administration of drugs that increase blood pressure (phenylephrine, pseudoephedrine, ephedrine, dihydroergotamine, thyroid hormones, or droxidopa); avoid concomitant use of drugs that increase blood pressure; if concomitant use cannot be avoided, monitor blood pressure closely
Avoid concomitant administration with MAO inhibitors or linezolid
It is essential to monitor supine and sitting blood pressures in patients receiving therapy; uncontrolled hypertension increases risk of cardiovascular events, particularly stroke
Avoid concomitant use with treatment agents that may cause vasoconstriction
Use caution in patients with diabetes mellitus, vision problems, and renal or hepatic impairment
Take drug no later than 6 pm and 3-4 hr before bed to minimize supine HTN
Pregnancy & Lactation
Pregnancy category: C
Lactation: Not known if excreted into breast milk; avoid
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Alpha-1 selective adrenergic agonist; increases peripheral vascular resistance; arteriolar and venous tone increases and results in a rise in sitting, standing, and supine systolic and diastolic blood pressure in patients with orthostatic hypotension
Absorption
Bioavailability: 93%
Onset: 45-90 min (initial effect); 60 min (max effect)
Duration: 2-3 hr
Peak plasma time: 1-2 hr (desglymidodrine); 30 min (midodrine)
Distribution
Protein bound: Minimal
Vd: <1.66 L/kg
Metabolism
Extensively undergoes enzymatic hydrolysis in the systemic circulation; prodrug (midodrine) converted to desglymidodrine (active agent)
Metabolites: Desglymidodrine, 15 times as potent as midodrine; primarily responsible for treatment activity (active)
Elimination
Half-life elimination: 3-4 hr (desglymidodrine); 25 min (midodrine)
Dialyzable: HD: Yes
Renal clearance: 385 mL/min
Excretion: Feces (1-2%); urine (80% [desglymidodrine])
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| midodrine oral - | 10 mg tablet |  | |
| midodrine oral - | 2.5 mg tablet |  | |
| midodrine oral - | 2.5 mg tablet |  | |
| midodrine oral - | 2.5 mg tablet |  | |
| midodrine oral - | 5 mg tablet |  | |
| midodrine oral - | 5 mg tablet |  | |
| midodrine oral - | 10 mg tablet |  | |
| midodrine oral - | 5 mg tablet |  | |
| midodrine oral - | 10 mg tablet |  | |
| midodrine oral - | 2.5 mg tablet |  | |
| midodrine oral - | 5 mg tablet |  | |
| midodrine oral - | 2.5 mg tablet |  | |
| midodrine oral - | 10 mg tablet |  | |
| midodrine oral - | 10 mg tablet |  | |
| midodrine oral - | 5 mg tablet |  | |
| midodrine oral - | 10 mg tablet |  | |
| midodrine oral - | 2.5 mg tablet |  | |
| midodrine oral - | 2.5 mg tablet |  | |
| midodrine oral - | 10 mg tablet |  | |
| midodrine oral - | 5 mg tablet |  | |
| midodrine oral - | 2.5 mg tablet |  | |
| midodrine oral - | 2.5 mg tablet |  | |
| midodrine oral - | 10 mg tablet |  | |
| midodrine oral - | 2.5 mg tablet |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
midodrine oral
MIDODRINE - ORAL
(MY-doh-dreen)
COMMON BRAND NAME(S): ProAmatine
WARNING: Midodrine should only be used in carefully selected patients. When you are lying on your back, this medication causes a significant increase in blood pressure. Your blood pressure will be monitored carefully during treatment.
USES: This medication is used for certain patients who have symptoms of low blood pressure when standing. This condition is also known as orthostatic hypotension. Midodrine is used in people whose daily activities are severely affected by this condition, even after other treatments are used (such as support stockings). It is known as a sympathomimetic (alpha receptor agonist) that acts on the blood vessels to raise blood pressure.
HOW TO USE: Take this medication by mouth with or without food as directed by your doctor, usually 3 times daily (at least 3 to 4 hours between doses). Follow all your doctor's instructions carefully. This drug is taken during daytime hours, when people stand most often. This medicine should not be taken after the evening meal or less than 4 hours before bedtime. Taking your dose is not recommended if you plan to lie down for a long time afterward (for example, if you plan on taking a nap).Dosage is based on your medical condition and response to treatment. Usually, your doctor will start you at a low dose and gradually increase your dose in order to reduce side effects. Do not increase your dose or take it more often than prescribed.Use this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day.Tell your doctor if your condition lasts or gets worse. This drug should be continued only in those people whose symptoms improve during treatment.
SIDE EFFECTS: Skin tingling, chills, "goose bumps," stomach pain, or urinary problems (strong/frequent urge to urinate, frequent urination, trouble urinating) may occur. Less common side effects include dry mouth, dizziness, drowsiness, trouble sleeping, or leg cramps. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.This medication can cause your blood pressure to increase, especially when you are lying down (supine hypertension). Stop taking midodrine and contact your doctor right away if you experience the following signs of supine hypertension: pounding heartbeat, pounding in the ears, headache, blurred vision.Tell your doctor right away if you have any serious side effects, including: slow heartbeat, unusual feeling in the chest, fainting, pressure/fullness in the head, confusion, anxiety, weakness, vision problems.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before taking midodrine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this drug, tell your doctor your entire medical history, including: high blood pressure, pheochromocytoma, overactive thyroid (hyperthyroidism), difficulty urinating (due to urinary retention or an enlarged prostate), heart disease, liver disease, kidney disease, diabetes.Get up slowly to reduce dizziness when rising from a sitting or lying position.This drug may rarely make you dizzy or drowsy or blur your vision. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while using midodrine. Midodrine may harm an unborn baby. If you become pregnant or think you may be pregnant, talk to your doctor right away about the risks and benefits of this medication.It is unknown if this medication passes into breast milk. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products have ingredients that could raise your blood pressure. Tell your pharmacist what products you are using, and ask how to use them safely (especially cough-and-cold products, diet aids, or NSAIDs such as ibuprofen/naproxen).
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include "goose bumps," difficulty urinating, feeling cold.
NOTES: Do not share this medication with others.Blood pressure checks (lying, sitting, and standing) should be routinely taken. Share the results with your doctor. (See also Side Effects section.)You may lessen high blood pressure while lying down by sleeping with the head of the bed lifted up.Lab and/or medical tests (such as kidney/liver function) should be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.
MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.
STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised May 2023. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
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- Compare formulary status to other drugs in the same class.
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