midodrine (Rx)

Brand and Other Names:ProAmatine, Orvaten
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Dosing & Uses

AdultPediatric

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

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Interactions

Interaction Checker

and midodrine

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            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

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            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

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            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.

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            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])

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            Images

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            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.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.