Midodrine hydrochloride

How it works

Its active metabolite desglymidodrine stimulates peripheral alpha-1 adrenoceptors, causing arterial and venous constriction that raises standing blood pressure.

Prescribing in practice

• Supine (lying) hypertension is the key hazard, so the last dose of the day should be taken several hours before lying down and patients should avoid dosing before bed.
• It is contraindicated in severe organic heart disease, urinary retention, phaeochromocytoma and significant hypertension.
• Doses are timed to periods of upright activity, and it should be avoided close to bedtime.

Monitoring

Monitor both standing and supine blood pressure regularly, and reduce or stop treatment if supine hypertension develops.

Counselling the patient

• Take your doses when you will be up and about, and not within a few hours of lying down or going to bed.
• Raise the head of your bed and report headache, pounding in the head or blurred vision when lying down.
• Tingling or goose bumps of the scalp and skin are common and harmless.

Evidence & guidelines

Midodrine is an established option in specialist management of symptomatic orthostatic hypotension where conservative measures and fludrocortisone are inadequate, as reflected in current prescribing references.