Midodrine

(mye' doe dreen)

Brand Name(s): Orvaten^®¶, Proamatine^®¶; also available generically

IMPORTANT WARNING:

Midodrine may cause supine hypertension (high blood pressure that occurs when lying flat on your back). This medication should only be used by people whose low blood pressure severely limits their ability to perform daily activities and who could not be treated successfully with other therapies. Tell your doctor if you have or have ever had high blood pressure. Tell your doctor and pharmacist if you are taking dihydroergotamine (DHE, Migranal). Also tell your doctor and pharmacist what other prescription and nonprescription medications you are taking, including ephedrine, phenylephrine, phenylpropanolamine, and pseudoephedrine. Many nonprescription products contain these medications (e.g. diet pills and medications for cough and colds), so check labels carefully. If you experience any of the following symptoms, stop taking midodrine and call your doctor immediately: awareness of your heartbeat, pounding in your ears, headache, or blurred vision. After beginning treatment, your doctor may tell you to continue taking midodrine only if you have significant improvement in your symptoms. Talk to your doctor about how you are feeling while taking this medication.

Keep all appointments with your doctor. You should have your blood pressure checked in the standing and lying flat positions before starting treatment and regularly while you are taking midodrine.

Talk to your doctor about the risks of taking midodrine.

WHY is this medicine prescribed?

Midodrine is used to treat orthostatic hypotension (sudden fall in blood pressure that occurs when a person assumes a standing position). Midodrine is in a class of medications called alpha-adrenergic agonists. It works by causing blood vessels to tighten, which increases blood pressure.

Are there OTHER USES for this medicine?

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

HOW should this medicine be used?

Midodrine comes as a tablet to take by mouth. It is usually taken three times a day during the daytime hours (such as morning, midday, and late afternoon [before 6PM]) with doses spaced at least 3 hours apart. Take the last daily dose of midodrine before an evening meal and at least 4 hours before bedtime. Take midodrine at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take midodrine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Take midodrine during daytime hours when you need to be upright. Avoid taking a dose when you will be lying down for any length of time. Also talk to your doctor about how to position yourself when you are lying down. Your doctor may tell you to raise the head of your bed when resting or sleeping.

What SPECIAL PRECAUTIONS should I follow?

Before taking midodrine,

• tell your doctor and pharmacist if you are allergic to midodrine, any other medications, or any of the ingredients in midodrine tablets. Ask your pharmacist for a list of the ingredients.

• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention the medications listed in the IMPORTANT WARNING section and any of the following: alpha blockers such as doxazosin (Cardura), prazosin (Minipress), and terazosin; beta blockers such as acebutolol (Sectral), atenolol (Tenormin, in Tenoretic), betaxolol, bisoprolol (Zebeta, in Ziac), carvedilol (Coreg), labetalol (Trandate), metoprolol (Lopressor, Toprol XL), nadolol (Corgard, in Corzide), pindolol, propranolol (Inderal, InnoPran XL), sotalol (Betapace, Betapace AF, Sorine), and timolol; digoxin (Lanoxin); fludrocortisone; and medications for mental illness. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

• tell your doctor if you have difficulty urinating, pheochromocytoma (tumor on a small gland near the kidneys), hyperthyroidism (condition that occurs when the thyroid gland produces too much thyroid hormone) or heart or kidney disease. Your doctor may tell you not to take midodrine.

• tell your doctor if you have or have ever had diabetes, vision problems, or liver disease.

• tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking midodrine, call your doctor.

What SPECIAL DIETARY instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do IF I FORGET to take a dose?

Take the missed dose as soon as you remember it, as long as it is at least 4 hours before your bedtime. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What SIDE EFFECTS can this medicine cause?

Midodrine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• numbness and tingling
• scalp itching
• goose bumps
• chills
• frequent urination
• urgent need to urinate
• difficulty urinating
• rash
• stomach pain

Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, stop taking midodrine and call your doctor immediately or get emergency medical treatment:

• slow heartbeat
• dizziness
• fainting

Midodrine may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

What should I know about STORAGE and DISPOSAL of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from light, excess heat and moisture (not in the bathroom).

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

What should I do in case of OVERDOSE?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

• awareness of your heartbeat
• pounding in your ears
• headache
• blurred vision
• goose bumps
• cold sensation
• difficulty urinating

What OTHER INFORMATION should I know?

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to midodrine.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

^¶ This branded product is no longer on the market. Generic alternatives may be available.

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. represents that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. makes no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS^® Patient Medication Information™. © Copyright, 2024. The American Society of Health-System Pharmacists^®, 4500 East-West Highway, Suite 900, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP.

Selected Revisions: February 15, 2021.