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Midodrine

Class
Sympathomimetics
Subclass
α-adrenergic receptor agonists
Generic name
Midodrine hydrochloride
Common formulations
Tablet
Dosage and administration
Adults patients
Treatment of orthostatic hypotension
•
10 mg PO TID
Other off-label uses
•
Treatment of dysautonomia
•
Treatment of postural orthostatic tachycardia syndrome
Indications for use
Labeled indications
Adults
•
Treatment of orthostatic hypotension
Off-label indications
Adults
•
Treatment of dysautonomia
•
Treatment of postural orthostatic tachycardia syndrome
Safety risks
Boxed warnings
Urinary retention
•
Use extreme caution with prostatic hypertrophy.
Contraindications
Concomitant use of MAOIs
Coronary artery disease
Pre-existing congestive HF
Warnings and precautions
Exacerbation of glycemic control
•
Use caution with diabetes mellitus.
Specific populations
Renal impairment
eGFR 20-50 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required.
eGFR 10-20 mL/min/1.73 m²
•
Reduce starting dose. Titrate to response.
eGFR < 10 mL/min/1.73 m²
•
Reduce starting dose. Titrate to response.
Renal replacement therapy
Continuous renal replacement
•
Reduce starting dose. Dose as in eGFR 10-20 mL/min/1.73 m². Titrate to response.
Intermittent hemodialysis
•
Start at a dose of 5mg if >70 kg, 2.5 mg if <70 kg. Titrate to response.
Peritoneal dialysis
•
Reduce starting dose. Dose as in eGFR < 10 mL/min/1.73 m². Titrate to response.
Hepatic impairment
Any severity
•
Use with caution.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: C
•
Use only if benefits outweigh potential risks. Evidence of fetal harm in animals.
Breastfeeding
Little information available on breastfeeding safety.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Very common > 10%
•
Hypertension, piloerection, dysuria, generalized pruritus, paresthesia
Common 1-10%
•
Pain, skin rash, shivering
Rare < 0.1%
•
Heartburn, nausea
Unknown frequency
•
Bradycardia, diaphoresis, erythema multiforme, hyperesthesia, orthostatic hypotension, pancytopenia, anxiety, asthenia, change in smell, change in taste, dizziness, dry mouth, flatulence, headache, insomnia, irritability, leg cramps, nervousness, restlessness, skin flushing, somnolence, weight gain, stomatitis, tachycardia, visual field defect
Interactions
Drug(s)
Check Interactions
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