Midodrine is a medication that is primarily used to treat a condition known as orthostatic hypotension. Orthostatic hypotension is a form of low blood pressure that occurs when a person stands up from a sitting or lying position, leading to symptoms such as dizziness, lightheadedness, and fainting.
Midodrine works by constricting (narrowing) the blood vessels, which increases blood pressure. This can help to alleviate the symptoms of orthostatic hypotension and allow individuals to maintain their blood pressure when changing positions.
Midodrine (gutron) is an alpha-1 receptor agonist. It causes vasoconstriction resulting in the elevation of blood pressure.
Midodrine (gutron) Uses:
- Hypotension, symptomatic orthostatic:
- Treatment of symptomatic orthostatic hypotension.
- Off Label Use of Midodrine in Adults:
- Refractory Ascites
- Hepatorenal Syndrome
- As a vasopressor-sparing drug to treat Hypotension in the ICU
- For the prevention of hemodialysis-induced Hypotension
- Vasovagal syncope
Midodrine Dose in Adults:
Note:
- Midodrine is a medicine for people who get dizzy or faint when they stand up because their blood pressure drops. This medicine helps by increasing their blood pressure.
- If someone takes a 10 mg dose of this medicine, their standing blood pressure can go up a bit (15 to 30 units) about an hour later. This effect might last for 2 to 3 hours.
Midodrine (gutron) Dose in the treatment of refractory ascites (off-label):
- he recommended dose of Midodrine for this condition is usually between 5 to 7.5 milligrams, and it should be taken three times a day.
- This dosage recommendation is based on guidelines from medical organizations.
Treatment of hepatorenal syndrome with midodrine (gutron) (off-label):
- Initial Dose: Start with a dose of 5 to 10 milligrams, and take it three times a day. This is the starting point.
- Maximum Dose: If needed, the doctor may increase the dose to a maximum of 12.5 milligrams or 15 milligrams, also taken three times a day.
The goal with this medication is to increase the mean arterial pressure (a measure of blood pressure) by at least 15 millimeters of mercury (mm Hg) from the baseline level.
Treatment of hypotension with midodrine (gutron) dose in the intensive care unit using vasopressor sparing agents:
- Initial Dose: Start with a dose between 5 to 20 milligrams, taken three times a day.
- Adjusting the Dose: The dose can be increased step by step until the patient no longer needs the IV vasopressors to maintain their blood pressure.
Using Midodrine in this situation aims to help reduce or eliminate the need for IV vasopressors, which can have side effects or risks when used for extended periods.
Doses of midodrine (gutron) used off-label to counteract hypotension brought on by hemodialysis
- Dose: Between 2.5 to 10 milligrams.
- Timing: This dose should be taken 15 to 30 minutes before starting the hemodialysis session.
The intention is to help stabilize blood pressure during hemodialysis, which can sometimes cause a significant drop in blood pressure.
Midodrine (gutron) Dose in the treatment of Hypotension, symptomatic orthostatic:
- Dose: Between 2.5 to 10 milligrams.
- Frequency: This dose is taken three times a day during the hours when the patient is awake and moving around. This usually means every 3 to 4 hours.
- Maximum Daily Dose: The total amount taken in one day should not exceed 40 milligrams.
- When to Avoid: It's important not to take this medication less than 4 hours before bedtime. This is to prevent too high of a blood pressure when lying down, a condition known as supine hypertension.
- Caution: If the patient's lying-down blood pressure (supine blood pressure) gets too high, the treatment should be stopped.
Midodrine (gutron) Dose in the treatment of Vasovagal syncope (off-label):
- Starting Dose: Between 2.5 to 10 milligrams.
- Frequency: This dose is taken three times a day during daytime hours, typically every 6 hours.
- Adjustments: If necessary, the dose can be increased up to 15 milligrams per dose to achieve the desired effect.
Use in Children:
The drug's effectiveness and safety in children have not been shown.
Pregnancy Risk Factor C
- Studies on animals showed that there might be harmful effects when using Midodrine during pregnancy.
- However, there's not much information about how Midodrine affects human pregnancies (Glatter, 2005).
Use of midodrine during lactation
- We don't know if Midodrine passes into breast milk.
- So, the company that makes the drug suggests being careful when giving it to women who are breastfeeding.
Midodrine (gutron) Dose in Kidney Disease:
- Start with a dose of 2.5 mg, taken three times a day.
- Slowly increase the dose as needed and as it's tolerated by the patient.
- Be careful when using this medication.
- If someone is on hemodialysis (a kidney treatment), the drug can be removed from the body during the treatment.
Midodrine (gutron) Dose in Liver disease:
- The company that makes the drug hasn't given special dosing instructions for people with liver problems because it hasn't been studied in that group.
- So, if someone has liver issues, they should be extra careful when using this medication.
Common Side Effects of Midodrine (gutron):
- Genitourinary:
- Dysuria
- Urinary retention
- Urinary urgency
- Central nervous system:
- Paresthesia
- Dermatologic:
- Piloerection
- Pruritus
- Renal:
- Polyuria
- Cardiovascular:
- Supine hypertension
Less Common Side Effects of Midodrine (gutron):
- Central nervous system:
- Chills
- Pain
- Gastrointestinal:
- Abdominal pain
- Dermatologic:
- Skin rash
Contraindications to Midodrine (gutron):
- Don't use the medication if someone has serious heart problems, sudden kidney issues, trouble emptying their bladder, certain tumors (pheochromocytoma), an overactive thyroid, very high blood pressure when lying down, or if their high blood pressure isn't well-controlled.
Warnings and precautions
Bradycardia
- This medication can slow down the heart rate, especially when taken with other drugs that also slow the heart, like digoxin or beta blockers.
- Be careful when using them together.
- If someone shows signs of a very slow heart rate while on the medication, stop using it.
Hypertension:
- This medication can cause high blood pressure, especially when lying down.
- If this persists, stop using the medication.
- Be extra careful when using it with other drugs that also raise blood pressure.
- Don't use it if someone's starting blood pressure when lying down is already very high (over 180 mm Hg).
- Only consider it for people who have serious health issues even after trying other treatments and lifestyle changes.
Diabetes:
- If someone has diabetes, they should be extra careful when using this medication.
Hepatic impairment
- If someone has liver problems, be extra careful when using this medication because it hasn't been studied in people with these issues.
Renal impairment
- The main active part of this medication mainly leaves the body through the kidneys.
- Before starting the medication, check how well the kidneys are working. If someone has kidney problems, be extra careful and start with a lower dose, because the effects on these patients haven't been studied.
- Don't use it in people with sudden severe kidney issues.
Visual problems
- Be careful when giving this medication to people with eyesight issues, especially if they are also taking fludrocortisone.
Midodrine: Drug Interaction
|
Risk Factor C (Monitor therapy) |
|
|
Alpha1-Blockers |
May diminish the vasoconstricting effect of Alpha1-Agonists. Similarly, Alpha1Agonists may antagonize Alpha1-Blocker vasodilation. |
|
AtoMOXetine |
May enhance the hypertensive effect of Sympathomimetics. AtoMOXetine may enhance the tachycardic effect of Sympathomimetics. |
|
Bradycardia-inducing Agents |
Midodrine may intensify the bradycardic effect of bradycardia-inducing substances. |
|
Cannabinoid-Containing Products |
May enhance the tachycardic effect of Sympathomimetics. Exceptions: Cannabidiol. |
|
Doxofylline |
Sympathomimetics may enhance the adverse/toxic effect of Doxofylline. |
|
Droxidopa |
Midodrine may enhance the hypertensive effect of Droxidopa. |
|
Guanethidine |
Might make sympathomimetics more arrhythmogenic. Guanethidine could make sympathomimetic drugs more hypertensive. |
|
Solriamfetol |
Sympathomimetics may intensify Solriamfetol's hypertensive effects. |
|
Sympathomimetics |
Might intensify the hazardous or harmful effects of other sympathomimetics. |
|
Tedizolid |
Might make sympathomimetics' hypertensive effects stronger. The tachycardic impact of sympathomimetics may be increased by tedizolid. |
|
Tricyclic Antidepressants |
Alpha1-Agonists' potential therapeutic effects could be improved. Tricyclic antidepressants may reduce the therapeutic effectiveness of Alpha1-Agonists |
|
Risk Factor D (Consider therapy modification) |
|
|
Benzylpenicilloyl Polylysine |
Alpha1-Agonists may diminish the diagnostic effect of Benzylpenicilloyl Polylysine. Management: Consider the use of a histamine skin test as a positive control to assess a patient's ability to mount a wheal and flare response. |
|
Cocaine (Topical) |
May enhance the hypertensive effect of Sympathomimetics. Management: Consider alternatives to the use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use. |
|
Linezolid |
Might make sympathomimetics' hypertensive effects stronger. Reduce initial sympathomimetic dosages and keep a careful eye out for individuals taking linezolid who exhibit an elevated pressor response. There are currently no suggestions for specific dosage adjustments. |
|
Risk Factor X (Avoid combination) |
|
|
Ergot Derivatives |
May enhance the hypertensive effect of Alpha1-Agonists. Ergot Derivatives may enhance the vasoconstricting effect of Alpha1-Agonists. Exceptions: Ergoloid Mesylates; Nicergoline. |
|
Iobenguane Radiopharmaceutical Products |
Iobenguane radiopharmaceutical products' therapeutic effects may be reduced by alpha1-agonists. Treatment: Before administering iobenguane, stop taking any medications that might impede or interfere with catecholamine transport or absorption for at least five biological half-lives. After each dosage of iobenguane, wait at least 7 days before administering these medications. |
|
Monoamine Oxidase Inhibitors |
Alpha1-Agonists' hypertensive effects could be amplified. Although this is the predicted mode of action for linezolid, treatment guidelines are different from those for other monoamine oxidase inhibitors. Details can be found in monographs that are particular to linezolid. Linezolid is an exception. |
Monitoring parameters:
- Renal function tests.
- Blood pressure while sitting, standing, and supine.
- Liver function tests.
How to administer Midodrine (gutron)?
Taking the Medication:
- Take doses about 3 to 4 hours apart.
- For example: in the morning when you wake up, at midday, and in the late afternoon (but not later than 6 PM).
Important Notes:
- Don't take it after dinner.
- Avoid taking it within 4 hours of going to bed to prevent high blood pressure when lying down.
Mechanism of action of Midodrine (gutron):
- Midodrine changes into a substance called desglymidodrine.
- Desglymidodrine acts like a switch for certain receptors called alpha receptors.
- When this switch is turned on, it makes the blood vessels in the body become narrower.
- This narrowing of blood vessels helps to increase blood pressure when a person is standing, sitting, or lying down, especially in people with orthostatic hypotension (low blood pressure when changing positions).
How Fast It Works:
- Starts working: ~1 hour after taking.
- Lasts for: 2 to 3 hours.
Getting into the Body:
- Absorbed quickly after taking.
- Doesn't easily pass into the brain because of the blood-brain barrier.
Binding & Interactions in the Body:
- Doesn't strongly attach to proteins in the blood.
Processing in the Body:
- Processed in the liver and other tissues.
- Midodrine changes into its active form called desglymidodrine.
Availability in the Body:
- About 93% of desglymidodrine is available in the body to work.
How Long It Stays in the Body:
- Desglymidodrine: stays about 3 to 4 hours.
- Midodrine: stays only 25 minutes.
Reaching Its Highest Level in Blood:
- Desglymidodrine: 1 to 2 hours after taking.
- Midodrine: 30 minutes after taking.
Leaving the Body:
- Through urine.
- Almost none of the original Midodrine is found in urine.
- About 80% of desglymidodrine is removed through urine by an active process.
International Brands of Midodrine:
- Amatine
- APO-Midodrine
- MAR-Midodrine
- Bramox
- Gutron
- Metligine
- Midodrine Hydrochloride
- Midon
- Midorine
- Midron
- Morepress
Midodrine Brand Names in Pakistan:
Midodrine is available in some hospitals. It is not freely available in the market.
