1. DRUG ACTION

Midodrine hydrochloride is a pro-drug of desglymidodrine. Desglymidodrine is a sympathomimetic agent which acts on peripheral alpha-adrenergic receptors to increase arterial resistance, resulting in an increase in blood pressure.

2. INDICATIONS AND DOSE

2.1 Severe orthostatic hypotension due to autonomic dysfunction

When corrective factors have been ruled out and other forms of treatment are inadequate

2.1.1 Adult:

Initially 2.5 mg 3 times a day, increased if necessary up to 10 mg 3 times a day. Dose to be increased at weekly intervals according to blood pressure measurements. Usual maintenance is 10 mg 3 times a day. Avoid administration at night; the last daily dose should be taken at least 4 hours before bedtime.

3. CONTRA-INDICATIONS

Aortic aneurysm
Blood vessel spasm
Bradycardia
Cardiac conduction disturbances
Cerebrovascular occlusion
Congestive heart failure
Hypertension
Hyperthyroidism
Myocardial infarction
Narrow-angle glaucoma
Phaeochromocytoma
Proliferative diabetic retinopathy
Serious obliterative blood vessel disease
Serious prostate disorder
Urinary retention

4. CAUTIONS

Atherosclerotic cardiovascular disease (especially with symptoms of intestinal angina or claudication of the legs)
Autonomic dysfunction
Elderly (manufacturer recommends cautious dose titration)
Prostate disorders

5. SIDE-EFFECTS

5.1 Common or Very Common

Chills
Flushing
Gastrointestinal discomfort
Headache
Nausea
Paraesthesia
Piloerection
Scalp pruritus
Skin reactions
Stomatitis
Supine hypertension (dose-dependent)
Urinary disorders

5.2 Uncommon

Anxiety
Arrhythmias
Irritability
Sleep disorders

5.3 Rare or Very Rare

Hepatic function abnormal
Palpitations

5.4 Frequency Not Known

Confusion
Diarrhoea
Vomiting

5.5 Side-Effects Further Information

Manufacturer advises that treatment must be stopped if supine hypertension is not controlled by reducing the dose.

6. CONCEPTION AND CONTRACEPTION

Manufacturer recommends effective contraception during treatment in women of childbearing potential.

7. PREGNANCY

Manufacturer advises avoidance due to toxicity in animal studies.

8. BREAST FEEDING

Manufacturer advises avoidance due to lack of information available.

9. RENAL IMPAIRMENT

Manufacturer advises avoidance in severe or acute impairment.

10. MONITORING REQUIREMENTS

Manufacturer advises measuring hepatic and renal function before treatment and at regular intervals during treatment.
Manufacturer advises regular monitoring of supine and standing blood pressure due to the risk of hypertension in the supine position.

11. PATIENT AND CARER ADVICE

Manufacturer advises that patients report symptoms of supine hypertension (such as chest pain, palpitations, shortness of breath, headache, and blurred vision) immediately. The risk of supine hypertension at night can be reduced by raising the head of the bed.

12. MEDICINAL FORMS

There can be variation in the licensing of different medicines containing the same drug.

Midodrine Hydrochloride