Medical term:
midodrine
midodrine
[mi´do-drēn″]a vasopressor used as the hydrochloride salt in treatment of orthostatic hypotension; administered orally.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.
midodrine
(mye-doe-dreen) ,ProAmatine
(trade name)Classification
Therapeutic: vasopressorsIndications
Symptomatic management of refractory orthostatic hypotension in patients whose livers are impaired.Urinary incontinence.
Action
Activation of alpha-1–adrenergic receptors in arteries and veins.
Therapeutic effects
Increase in vascular tone and BP.
Pharmacokinetics
Absorption: 93% absorbed following oral administration; rapidly converted to desglymidodrine, the active metabolite.
Distribution: Desglymidodrine crosses the blood-brain barrier poorly.
Metabolism and Excretion: Desglymidodrine is 80% excreted by the kidneys.
Half-life: Midodrine—25 min; desglymidodrine—3–4 hr.
Time/action profile (blood levels of active metabolite)
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| PO | rapid | 1–2 hr | 2–3 hr |
Contraindications/Precautions
Contraindicated in: Urinary retention; Severe organic heart disease; Acute renal disease; Persistent/excessive supine hypertension; Pheochromocytoma; Thyrotoxicosis.
Use Cautiously in: History of hypertensionRenal impairment (↓ initial dose); Hepatic impairment; Diabetes mellitus, visual problems, concurrent fludrocortisone (↑ risk of visual disturbances); Obstetric / Pediatric: Pregnancy, lactation or children (safety not established).
Adverse Reactions/Side Effects
Central nervous system
- anxiety
- confusion
- head pressure/fullness
- headache
- nervousness
Cardiovascular
- supine hypertension (most frequent)
- bradycardia
Genitourinary
- urinary urge/retention/frequency (most frequent)
- dysuria (most frequent)
Dermatologic
- facial flushing
- piloerection (most frequent)
- pruritus (most frequent)
- rash
Neurologic
- paresthesia (most frequent)
Miscellaneous
- chills
- pain
Interactions
Drug-Drug interaction
↑ risk of bradycardia with digoxin, beta blockers, and antipsychotics.Concurrent use with other alpha-adrenergic agonists including phenylephrine, ephedrine, pseudoephedrine, and dihydroergotamine may result in ↑ pressor effect.Effects may be ↓ by alpha-adrenergic blockers including prazosin, terazosin, and doxazosin.↑ Effects of fludrocortisone (↓ initial dose of fludrocortisone or ↓ salt intake prior to midodrine).Route/Dosage
Oral (Adults) Orthostatic hypotension—10 mg three times daily; urinary incontinence—2.5–5 mg two to three times daily.
Renal Impairment
Oral (Adults) 2.5 mg three times daily.Availability (generic available)
Tablets: 2.5 mg, 5 mg, 10 mg
Nursing implications
Nursing assessment
- Monitor supine and sitting BP prior to and during therapy.
- Assess pattern of urinary output prior to and during treatment for incontinence.
- Lab Test Considerations: Monitor renal and hepatic function prior to and periodically during therapy.
Potential Nursing Diagnoses
Decreased cardiac output (Indications)Risk for injury (Indications)
Implementation
- Oral: Administer 3 times daily at 3–4 hr intervals. Do not administer after last meal or within 4 hr of bedtime.
Patient/Family Teaching
- Instruct patient to take midodrine as directed. First dose should be taken on or shortly after arising, second dose at midday, and third dose should be taken before evening meal and at least 4 hr before bedtime. Take missed doses as soon as remembered unless almost time for next dose; do not double doses.
- Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
Evaluation/Desired Outcomes
- Decrease in signs and symptoms of orthostatic hypotension.
- Decrease in the incidence of urinary incontinence.
Drug Guide, © 2015 Farlex and Partners
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