α1 adrenergic agonist
Midodrine hydrochloride
Brand names: Bramox
Adult dose
Dose: Initial 2.5mg TDS, increase to max 10mg TDS
Route: PO
Frequency: TDS (last dose ≥4h before bedtime)
Clinical pearls
- Severe orthostatic hypotension when non-pharmacological measures fail
- Last dose ≥4h before bed to avoid supine hypertension
Contraindications
- Severe organic heart disease
- Severe peripheral vascular disease
- Phaeochromocytoma
- Hyperthyroidism
- Acute renal disease
- Urinary retention
- Closed-angle glaucoma
- Pregnancy
Side effects
- Supine hypertension
- Piloerection / scalp tingling
- Urinary retention
- Bradycardia (reflex)
Interactions
- MAOIs
- Sympathomimetics
- Antihypertensives
- Cardiac glycosides
Monitoring
- Standing/supine BP
Reference: BNF; NICE; SmPC; https://bnf.nice.org.uk/drugs/midodrine-hydrochloride/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Pathways
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines