Classes
DEA Class; Rx
Common Brand Names; ProAmatine, Orvaten
- Alpha1 Agonists
Description
Alpha-1 selective adrenergic agonist; increases peripheral vascular resistance; arteriolar and venous tone increases and results in a rise in sitting, standing, and supine systolic and diastolic blood pressure in patients with orthostatic hypotension
Indications
Indicated in Symptomatic Orthostatic Hypotension, Stress Incontinence (Off-label)
Contraindications
Severe organic heart disease, supine HTN, acute renal disease, urinary retention, pheochromocytoma, thyrotoxicosis
Adverse Effects
- Paresthesia (18%)
- Piloerection (13%)
- Pruritus (13%)
- Supine hypertension (7-13%)
- Urinary retention or urgency (up to 13%)
- Chills (5%)
- Pain, including abdominal pain (5%)
- Rash (2%)
- <1%
- Anxiety
- Canker sore
- Confusion
- Dizziness
- Dry skin
- Erythema multiforme
- Facial flushing
- Flushing
- Headache
- Hyperesthesia
- Insomnia
- Intracranial pressure increased
- Nausea
- Somnolence
- Weakness
- Xerostomia
Warnings
May slow heart rate primarily due to vagal reflex; use caution when administering concomitantly with negative chronotropes, including digoxin, beta blockers, or other agents that decrease heart rate; discontinue use if signs or symptoms of bradycardia occur
Risk of hypertension increases with concomitant administration of drugs that increase blood pressure (phenylephrine, pseudoephedrine, ephedrine, dihydroergotamine, thyroid hormones, or droxidopa); avoid concomitant use of drugs that increase blood pressure; if concomitant use cannot be avoided, monitor blood pressure closely
Avoid concomitant administration with MAO inhibitors or linezolid
It is essential to monitor supine and sitting blood pressures in patients receiving therapy; uncontrolled hypertension increases risk of cardiovascular events, particularly stroke
Avoid concomitant use with treatment agents that may cause vasoconstriction
Use caution in patients with diabetes mellitus, vision problems, and renal or hepatic impairment
Take drug no later than 6 pm and 3-4 hr before bed to minimize supine HTN
Pregnancy and Lactation
Pregnancy category: C
Lactation: Not known if excreted into breast milk; avoid
Maximum Dosage
Adults
Symptomatic Orthostatic Hypotension
2.5-10 mg PO q8hr
Usual dose: 10 mg PO q8hr
Doses greater than 30 mg/day have not been studied; should not exceed 40 mg/day
Stress Incontinence (Off-label)
2.5-5 mg PO q8-12hr
Pediatric
Safety & efficacy not established
How supplied
Midodrine hydrochloride
tablet
- 2.5mg
- 5mg
- 10mg