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Alpha₁-Adrenergic Agonist (Vasopressor — Oral)

Midodrine

Brand names: Bramox, ProAmatine

Used in: Syncope

Midodrine is an orally active alpha-1 adrenergic agonist used to treat severe orthostatic hypotension, and in hepatology it is used off-label as a vasoconstrictor in conditions such as hepatorenal syndrome.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

Its active metabolite desglymidodrine stimulates peripheral alpha-1 adrenoceptors, causing arteriolar and venous vasoconstriction that raises peripheral vascular resistance and blood pressure.

Prescribing in practice

  • It can cause marked supine hypertension, so doses should be avoided shortly before lying down and not given late in the evening.
  • It is contraindicated in severe organic heart disease, acute kidney disease, phaeochromocytoma and thyrotoxicosis.
  • Use cautiously with other vasopressors and in urinary retention given its alpha-agonist effects on the bladder neck.

Monitoring

Monitor both supine and standing blood pressure, and review for symptoms of supine hypertension such as headache or visual disturbance.

Counselling the patient

  • Advise patients not to take a dose just before going to bed and to raise the head of the bed if supine hypertension occurs.
  • Tell patients to report scalp tingling, goosebumps or urinary difficulty, which are common alpha-agonist effects.

Evidence & guidelines

Midodrine's use in orthostatic hypotension is established, and its role in hepatorenal syndrome reflects specialist hepatology practice rather than a licensed indication.

Reference: EASL Cirrhosis Guidelines 2018; CONFIRM Trial (Wong et al, NEJM 2021); SPC Bramox; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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