Midodrine, orthostatic hypotension

In patients taking midodrine for orthostatic hypotension, the nurse checks the blood pressure with the patient supine and sitting before therapy is begun. This is important because midodrine is contraindicated in patients with supine hypertension. 

The following isa suggested dosing schedule for the administration of midodrine shortly before arising in the morning, midday, and late afternoon (not after 6 00 fm). The nurse should continue drug therapy only in the patient whose orthostatic hypotension improves during the initial treatment. 

EDUCATING THE PATIENT PRESCRIBED MIDODRINE When midodrine is given to patients with severe orthostatic hypotension, tiie nurse explains the importance of... 

Midodrine (ProAmatine) Pressor Tab 2.5,5 mg Initially 2.5 mg tid, titrate to 10 mg tid. Paresthesia, piloerection, urinary retentbn used for orthostatic hypotension. 

Increasing peripheral resistance is one of the strategies to treat chronic orthostatic hypotension, and drugs activating receptors can be used for this purpose. Midodrine, an orally active 04 agonist, is frequently used for this indication. Other sympathomimetics, such as oral ephedrine or phenylephrine, can be tried. 

Indications Treatment of symptomatic orthostatic hypotension. Midodrine can cause marked elevation of supine blood. It should be used in patients whose lives are considerably impaired despite standard clinical care, including non-pharmacologic treatment (such as support stockings), fluid expansion, and lifestyle alterations. 

In a controlled study of octreotide and midodrine (an alpha-adrenoceptor agonist) in patients with orthostatic hypotension, the pressor effect of the two drugs was synergistic (56). 

Hoeldtke RD, Horvath GG, Bryner KD, Hobbs GR. Treatment of orthostatic hypotension with midodrine and octreotide. J Clin Endocrinol Metab 1998 83(2) 339-43. 

Midodrine (ProAmatine). Midodrine can be administered orally to treat resistant cases of orthostatic hypotension. This drug can also prevent hypotension in patients undergoing dialysis, and it can offset the hypotensive effects of certain psychotropic drugs (e.g., antipsychotic medications). 

Midodrine has been extensively tested in several of the orthostatic hypotension sjmdromes, including neurogenic hjrpertension due to autonomic neuropathies (2,3) neu-rocardiogenic syncope (4-8) the controversial syndrome of orthostatic hypotension and tachycardia that may be associated with chronic fatigue (9,10) the hypotension seen during hemodialysis (11) and hypotension due to neuroleptic drugs (12). 

In a 4-week, double-blind, placebo-controlled study in 97 patients with orthostatic hypotension aged 22-86 years (mean age 61 years) midodrine 2.5,5, or 10 mg was given three times a day for 4 weeks (5). Midodrine 10 mg significantly increased standing systolic blood pressure by... 

Mauro VF. Focus on midodrine an oral peripheral-acting alpha-agonist for the treatment of orthostatic hypotension. Formulary 1997 32 225-31. 

Low PA, Gilden JL, Freeman R, Sheng KN, McElligott MA Efficacy of midodrine vs placebo in neurogenic orthostatic hypotension. A randomized, double-blind multicenter study. Midodrine Study Group. JAMA 1997 277(13) 1046-51. 

Jankovic J, Gilden JL, Hiner BC, Kaufmann H, Brown DC, Coghlan CH, Rubin M, Fouad-Tarazi FM. Neurogenic orthostatic hypotension a double-blind, placebo-controlled study with midodrine. Am J Med 1993 95(1) 38 8. 

Midodrine is a selective venopressor, and thus is efficacious for the therapy of orthostatic hypotension. 

A. Orthostatic hypotension. The most important is to limit use of vasoactive substances. If non-pharmacologic measures are not mough then fludrocortisone should be tried starting with a dose of 0.1 mg at bedtime and increased to 0.4 mg/day [38], Side effects are oedema and recumbent hypertension. Other compounds that have been tested with positive results include Erythropoietin, Octreotide, desmopressin and midodrine. 

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