Midodrine (米多君) is a medication used to treat hypotension, classified as an alpha-1 adrenergic receptor agonist. Its primary function is to constrict peripheral blood vessels, increase blood pressure, and improve symptoms such as dizziness, lightheadedness, or fainting caused by chronic low blood pressure. This medication is typically used for neurological conditions (such as autonomic dysfunction) or post-surgical orthostatic hypotension, but must be used under strict medical evaluation.
The goal of Midodrine therapy is to elevate standing blood pressure to a safe range, but its effects usually last only a few hours. Physicians will adjust the dosage based on the patient’s age, medical history, and symptom severity, and regularly monitor blood pressure changes. This drug is not suitable for treating hypertension and may interact with other antihypertensive medications.
The generic name of Midodrine is Midodrine, with main brand names including:
Other brand names may exist in different countries or regions; patients should refer to the medication label. Generic and brand-name drugs contain the same active ingredients, but dosage forms may vary slightly, and should be used as prescribed by a healthcare professional.
Midodrine is classified as a peripheral alpha-1 adrenergic receptor agonist. Its main mechanism of action is to selectively stimulate alpha-1 receptors in blood vessels, causing vasoconstriction. This class of drugs is generally used to improve peripheral circulation issues, but due to its short duration of action, it requires multiple doses throughout the day.
Unlike other vasopressors, Midodrine’s vasoconstrictive effects are primarily limited to the skin and peripheral vessels, with minimal impact on visceral blood vessels. Therefore, it can effectively treat orthostatic hypotension with less interference in visceral blood supply.
The main indications for Midodrine include:
This medication is typically used when non-pharmacological treatments (such as salt intake or compression stockings) are ineffective. In Taiwan, it can only be used with a physician’s prescription.
It is not suitable for treating primary hypertension or acute hypertensive crises. Patients should not adjust the dosage on their own to avoid adverse effects.
Mild side effects include:
Serious side effects requiring immediate medical attention:
The following patients should avoid using this medication:
Pregnant or breastfeeding women should inform their doctor as the effects on the fetus or infant are not yet confirmed. Elderly patients over 65 should start with a lower dose to prevent excessive blood pressure elevation.
Using with the following medications may increase risks:
When taking diuretics or other antihypertensive drugs, dosage adjustments of Midodrine may be necessary. Avoid combining with alcohol, as it may worsen dizziness or hypotension.
The usual starting dose for adults is 2.5 mg, taken three times daily while awake. The maximum total daily dose should not exceed 30 mg. Tablets should be swallowed whole and not chewed or broken.
Timing should be scheduled during daytime activity periods, as the drug’s effect lasts approximately 3-4 hours. Do not take before bedtime to prevent nocturnal hypertension or sleep disturbances.
If a dose is missed and more than 2 hours remain before the next scheduled dose, take it as soon as possible. If the timing is close to the next dose, skip the missed dose and resume normal schedule. Do not double the dose to make up for a missed one.
If missed doses lead to worsening symptoms over time, contact your physician immediately to adjust the medication plan. Do not alter the dose on your own.
Overdose may cause hypertensive crisis, with symptoms such as severe headache, blurred vision, chest pain, or difficulty breathing. Seek immediate medical attention and bring the medication packaging for assessment.
Emergency measures may include continuous blood pressure monitoring and, in severe cases, administration of antihypertensive agents. Do not attempt to treat overdose yourself; go to the emergency room immediately.
Why should I avoid lying down or reclining after taking Midodrine?
Midodrine increases blood pressure. Lying down shortly after taking it may cause excessive blood flow to the head, leading to headache or dizziness. It is recommended to remain seated or standing for at least 15 to 30 minutes after taking the medication to reduce discomfort.
How can I manage dry mouth caused by Midodrine?
Dry mouth is a common side effect. It can be alleviated by chewing sugar-free gum or using lozenges to stimulate saliva, or by using artificial saliva products. If dry mouth significantly affects daily life, discuss dosage adjustments with your doctor instead of stopping the medication on your own.
What should I be aware of when using other antihypertensive drugs with Midodrine?
Midodrine may antagonize the effects of other blood pressure medications, reducing their efficacy. If combining with beta-blockers or diuretics, your doctor will adjust the dosage based on blood pressure monitoring. Always inform your healthcare provider of all medications you are taking.
What should I do if my blood pressure becomes too high after taking Midodrine?
If symptoms like headache or blurred vision occur indicating high blood pressure, sit down or lower your head while sitting. Avoid sudden standing. Measure your blood pressure immediately and record the readings, then contact your healthcare provider promptly to evaluate whether medication adjustments are needed.
What health checks are recommended for long-term users of Midodrine?
Long-term users should have their blood pressure, kidney function, and electrocardiogram monitored every 3 to 6 months. Your doctor will adjust the dosage based on blood pressure logs and symptoms. Do not stop medication abruptly due to symptom improvement; gradually reduce to prevent rebound hypertension.
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