about Midodrine class, uses, side effects contraindications
Midodrine
Short Description
Midodrine is?one of the drugs used to treat? orthostatic?hypotension??, which occurs when moving from one position to another, and it may also sometimes be used to treat stress incontinence, where its mechanism of action depends on the narrowing of peripheral blood vessels. Which leads to an increase in blood pressure.
Midodrine may cause a significant increase in blood pressure, especially while lying down. Therefore, it is recommended to take the dose at least 4 hours before bedtime, and blood pressure should be monitored during the treatment period.
Category
Chemical class: Desglymidodrine prodrug
Therapeutic class: Antihypotensive, vasopressor
Pregnancy category: C
Indications
To treat symptomatic orthostatic hypotension
Adults. 10 mg t.i.d. in 3to 4-hr intervals.
DOSAGE ADJUSTMENT Initial dose possibly reduced to 2.5 mg for patients with renal impairment. Route Onset Peak Duration P.O. Unknown 30 min 2–3 hr
Mechanism of Action
Is broken down into the active metabolite desglymidodrine. Desglymidodrine directly stimulates alpha-adrenergic receptors in arteries and veins. This action increases total peripheral vascular resistance, which in turn increases systolic and diastolic blood pressure.
Contraindications
Acute renal disease, hypersensitivity to midodrine or its components, initial supine systolic pressure above 180 mm Hg, persistent and excessive supine hypertension, pheo-chromocytoma, severe heart disease, thyrotoxicosis, urine retention
Interactions
beta blockers, digoxin: Enhanced or precipitated bradycardia, AV block, arrhythmias cimetidine, flecainide, metformin, procainamide, quinidine, ranitidine, triamterene: Possibly decreased renal clearance of these dihydroergotamine, ephedrine, phenylephrine, phenylpropanolamine, pseudoephedrine: Increased vasopressor effects doxazosin, prazosin, terazosin: Antagonized midodrine effects fludrocortisone acetate: Increased risk of supine hypertension
Side Efect
CNS: Anxiety, asthenia, chills, confusion, delusions, dizziness, feeling of pressure or fullness in head, headache, hyperesthesia, insomnia, nervousness, paresthesia, somnolence
CV: Hypertension (sitting and supine), vasodilation
EENT: Canker sore, dry mouth, vision changes
GI: Flatulence, indigestion, nausea
GU: Dysuria, urinary frequency and urgency, urine retention
MS: Back pain, leg cramps
SKIN: Dry skin, erythema multiforme, facial flushing, piloerection, rash, scalp pruritus
Cautions
Monitor hepatic and renal function, as ordered, before and during midodrine therapy. Give drug at 3to 4-hour intervals, if ordered and needed to control symptoms. Don’t give after evening meal, less than 4 hours before bed, or more often than every 3 hours.
WARNING Monitor for severe, persistent systolic supine hypertension, which may develop with single doses up to 20 mg. Avoid placing patient flat in bed for any length of time. Elevate head of bed when patient is supine. Monitor supine and sitting blood pressure often during midodrine therapy. PATIENT SAFTY
Instruct patient to take midodrine every 3 to 4 hours during daytime but not to take final dose after evening meal or within 4 hours of going to bed. Advise patient to elevate head of bed when he lies supine. Caution him not to remain flat for any length of time. Direct patient to notify prescriber immediately about headache, increased dizziness, urine retention, or vision changes. Encourage patient to keep follow-up appointments to monitor blood pressure and hepatic and renal function.
Trade Name & Company Name
effect of Midodrine in Pregnancy, Fetal Health
and Breast feeding
Pregnancy
. Midodrine increases vascular tone and elevates BP. In a single case report, midodrine was used successfully to treat postural 719 orthostatic tachycardia syndrome (POTS), a rare disease characterized by syncope, sinus tachycardia, and orthostasis due to autonomic dysfunction. Rodent studies reveal no effect on uterine contractility in vitro. Fetal Health
There are no adequate reports or well-controlled studies in human fetuses. It is unknown whether midodrine crosses the human placenta. Though no evidence of teratogenicity was found in rodent studies, there was an increased prevalence of embryo resorption and IUGR. Breastfeeding
There is no published experience in nursing women. It is unknown whether midodrine enters human breast milk.
the follwing drugs will increse Midodrine by inhepiting cyp450
the follwing drugs will decrease Midodrine by inhancing cyp450
trad drugs based on Midodrine
| Gen name | Trade name | Catagory name |
| midodrine | Orvaten | Miscellaneous cardiovascular agents |
| midodrine | ProAmatine | Miscellaneous cardiovascular agents |
| Midodrine | GUTRON INJECTION 5MG-2ML | |
| Midodrine | GUTRON TAB 2.5 MG TAB | |
other drugs from same cataogory