Trade Names:ProAmatine- Tablets 2.5 mg- Tablets 5 mg- Tablets 10 mgApo-Midodrine (Canada)
Activates arteriolar and venous α-adrenergic receptors, resulting in an increase in vascular tone and elevation of BP.
Midodrine is rapidly absorbed. Absolute bioavailability is 93%, prodrug T max is 30 min, and metabolite T max is 1 to 2 h.
Neither prodrug nor metabolite is bound to plasma proteins to any significant extent.
Major active metabolite is desglymidodrine. Declycination of midodrine to desglymidodrine takes place in many tissues. Both compounds are metabolized in part by the liver.
Renal Cl of desglymidodrine is 385 mL/min (approximately 80% by active renal secretion). The t ½ is 25 min (midodrine) and 3 to 4 h (desglymidodrine).
Time to peak is 1 h.
Duration is 2 to 3 h.
Use cautiously in patients with urinary retention problems. A lower starting dose (2.5 mg) may be necessary. Assess renal function prior to initial use.Hepatic Function Impairment
Use with caution, as the liver has a role in the metabolism.
Treatment of symptomatic orthostatic hypotension in patients whose lives are considerably impaired despite standard clinical care, including support stockings, fluid expansion, and lifestyle changes.
Management of urinary incontinence.
Severe organic heart disease, acute renal failure, urinary retention, phenochromocytoma, thyrotoxicosis, or in patients with persistent and excessive supine hypertension.
PO 10 mg 3 times daily during daytime hours.Renal Function ImpairmentAdults
PO Start with 2.5 mg/dose.
Store tablets at controlled room temperature (59° to 86°F).
May antagonize pressor effects of midodrine.Cardiac glycosides (ie, digitalis), beta-blockers
May precipitate bradycardia, AV block, or arrhythmia.Fludrocortisone
May exacerbate supine hypertension.Vasoconstrictors (eg, dihydroergotamine, ephedrine, phenylephrine, phenylpropanolamine, pseudoephedrine)
May enhance pressor effects of midodrine.
None well documented.
Supine and sitting hypertension (7%); bradycardia.
Paresthesia (18%); headache; confusion; nervousness; anxiety; confusion; abnormal thinking.
Piloerection (13%); scalp pruritus (12%); rash (2%).
Abdominal pain; dry mouth.
Dysuria (frequency, impaired micturition, urinary retention, urinary urgency) (13%).
Pain, chills (5%); facial flushing; feeling of fullness/pressure in head.
Because the drug can cause significant hypertension, use only in patients whose lives are considerably impaired despite critical care. Clinical benefits have not been verified.
Category C .
Safety and efficacy not established.
Use with caution. Initiate therapy with smaller doses.
Use with caution.
May occur because of vagal reflex. Use caution when coadministering with other agents that can reduce heart rate (eg, cardiac glycosides, beta-blockers, psychopharmacologic agents).
Use with caution.
Potentially most serious adverse reaction. Most common in patients with elevated pretreatment supine systolic BP (mean, 170 mm Hg). Use is not recommended in patients with pretreatment supine systolic BP above 180 mm Hg. Monitor supine and sitting BPs.
Use with caution because of effect on α-adrenergic receptors of bladder neck.
Hypertension, piloerection, sensation of coldness, urinary retention.
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