In the U.S.—

• Antihypotensive
• vasopressor

Midodrine (MI-doe-dreen) is a medicine used to treat low blood pressure (hypotension). It works by stimulating nerve endings in blood vessels, causing the blood vessels to tighten. As a result, blood pressure is increased.

This medicine is available only with your doctor's prescription, in the following dosage form:

Oral
• Tablets (U.S.)

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For midodrine, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to midodrine. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy—Midodrine has not been studied in pregnant women. However, studies in animals have shown that large doses of midodrine can cause reduced body weight in rat fetuses and decreased survival in rabbit fetuses. Before taking this medicine, make sure your doctor knows if you are pregnant or may become pregnant.

Breast-feeding—It is not known if midodrine passes into breast milk. However, it has not been reported to cause problems in nursing babies.

Children—This medicine has been tested in a limited number of children 6 months to 12 years of age. In effective doses, the medicine has not been shown to cause different side effects or problems than it does in adults.

Older adults—This medicine has been tested and has not been shown to cause different side effects or problems in older people than it dose in younger adults.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking midodrine, it is especially important that your health care professional know if you are taking any of the following:

• Digitalis glycosides (e.g., Lanoxin)—Effects on the heart may be increased

• Steroids that cause sodium retention, such as fludrocortisone (e.g., Florinef) or
• Vasoconstricting medication, such as dihydroergotamine (e.g., Migranal), and ephedrine, phenylephrine, phenylpropanolamine, or pseudoephedrine (ingredients in many cough/cold combination products)—Effects on blood pressure may be increased

• Heart disease, severe or
• Hypertension (high blood pressure) or
• Overactive thyroid or
• Visual problems—Effects of midodrine on blood pressure may aggravate these problems

• Kidney disease or
• Liver disease—Effects of midodrine may be increased because of slower removal of the medicine from the body

• Urinary retention—Effects of midodrine on the bladder may aggravate this condition

The last dose of midodrine should not be taken after the evening meal or less than 3 to 4 hours before bedtime because high blood pressure upon lying down (supine hypertension) can occur, which can cause blurred vision, headaches, and pounding in the ears while lying down after taking this medicine.

Also, midodrine should not be taken if you will be lying down for any length of time.

Dosing—

The dose of midodrine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of midodrine. If your dose is different, do not change it unless your doctor tells you to do so.

The number of tablets that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are taking midodrine.

• For oral dosage form (tablets):
  • Low blood pressure (hypotension):
    • Adults—10 milligrams (mg) three times a day in approximately four-hour intervals during the daytime hours: shortly before or upon rising in the morning, at midday, and in the late afternoon (not later than six p.m.). Your doctor may increase your dose if needed.
    • Children—Use and dose must be determined by your doctor.

Missed dose—

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—

To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

Do not take other medicines unless they have been discussed with your doctor. This especially includes over-the-counter (nonprescription) medicines for appetite control, asthma, colds, cough, hayfever, or sinus problems, since they may tend to increase your blood pressure.

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• More common
  • Blurred vision, cardiac awareness, headache, and/or pounding in the ears 
  
  

• Rare
  • Fainting;  increased dizziness;  slow pulse 
  
  

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

• More common
  • Burning, itching, or prickling of the scalp;  chills;  goosebumps;  urinary frequency, retention, or urgency 
  
  

• Less common
  • Anxiety or nervousness;  confusion;  dry mouth;  flushing;  headache or feeling of pressure in the head;  skin rash 
  
  

• Rare
  • Backache;  canker sores;  dizziness;  drowsiness;  dry skin;  leg cramps;  pain or sensitivity of skin to touch;  stomach problems such as gas, heartburn, or nausea;  trouble in sleeping ;  trouble seeing;  weakness  
  
  

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although not specifically included in product labeling, midodrine is used in certain patients with the following medical conditions:

• Low blood pressure (hypotension) caused by kidney dialysis
• Low blood pressure caused by certain medicines used to treat mental illness
• Low blood pressure in children with an infection