Midodrine

Brand names: Orvaten™, ProAmatine®

Chemical formula:

Español:
• Clorhidrato de Midodrina, Tableta oral

Midodrine Hydrochloride Oral tablet

What is this medicine?

MIDODRINE is used to treat low blood pressure in patients who have symptoms like dizziness when going from a sitting to a standing position.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

What should I tell my health care provider before I take this medicine?

They need to know if you have any of the following conditions:
• difficulty passing urine
• heart disease
• high blood pressure
• kidney disease
• over active thyroid
• pheochromocytoma
• an unusual or allergic reaction to midodrine, other medicines, foods, dyes, or preservatives
• pregnant or trying to get pregnant
• breast-feeding

How should I use this medicine?

Take this medicine by mouth with a glass of water. Follow the directions on the prescription label. The last dose of this medicine should not be taken after the evening meal or less than 4 hours before bedtime. When you lie down for any length of time after taking this medicine, high blood pressure can occur. Do not take this medicine if you will be lying down for any length of time. Do not take your medicine more often than directed. Do not stop taking except on your doctor's advice.

Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.
NOTE: This medicine is only for you. Do not share this medicine with others.

What may interact with this medicine?

Do not take this medicine with any of the following medications:
• MAOIs like Carbex, Eldepryl, Marplan, Nardil, and Parnate
• medicines called ergot alkaloids
• medicines for colds and breathing difficulties or weight loss
• procarbazine

This medicine may also interact with the following medications:
• cimetidine
• digoxin
• flecainide
• fludrocortisone
• metformin
• procainamide
• quinidine
• ranitidine
• triamterene
• medicines called alpha-blockers like doxazosin, prazosin, and terazosin

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medicine?

Visit your doctor or health care professional for regular checks on your progress.

You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how this medicine affects you. Do not stand or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells.

Your mouth may get dry. Chewing sugarless gum or sucking hard candy, and drinking plenty of water may help. Contact your doctor if the problem does not go away or is severe.

Do not treat yourself for coughs, colds, or pain while you are taking this medicine without asking your doctor or health care professional for advice. Some ingredients may increase your blood pressure.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:
• awareness of heart beating
• blurred vision
• headache
• irregular heartbeat, palpitations, or chest pain
• pounding in the ears
• skin rash, hives

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):
• change in heart rate
• chills
• goose bumps
• increased need to urinate
• itching
• stomach pain
• tingling in the skin or scalp

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medicine?

Keep out of the reach of children.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Throw away any unused medicine after the expiration date.

Last updated: 7/1/2002

Important Disclaimer: The drug information provided here is for educational purposes only. It is intended to supplement, not substitute for, the diagnosis, treatment and advice of a medical professional. This drug information does not cover all possible uses, precautions, side effects and interactions. It should not be construed to indicate that this or any drug is safe for you. Consult your medical professional for guidance before using any prescription or over the counter drugs.

Midodrine

Systematic (IUPAC) name
N-[2-(2,5-dimethoxyphenyl)-2-hydroxyethyl]glycinamide
Identifiers
CAS number	133163-28-7
ATC code	C01CA17
PubChem	4195
DrugBank	APRD01116
Chemical data
Formula	C12H18N2O4
Mol. mass	254.282 g/mol
SMILES	eMolecules & PubChem
Synonyms	2-amino-N-[2-(2,5-dimethoxyphenyl)-2-hydroxy-ethyl]-acetamide
Pharmacokinetic data
Bioavailability	?
Metabolism	?
Half life	?
Excretion	?
Therapeutic considerations
Pregnancy cat.	?
Legal status
Routes	?
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Midodrine is a vasopressor/antihypotensive agent, it is an odorless, white, crystalline powder, soluble in water and sparingly soluble in methanol.

Contents 1 Mechanism of Action 2 Metabolism 3 Indications 4 Contraindications 5 Side Effects 6 References 7 External links

Mechanism of Action

Midodrine hydrochloride forms an active metabolite, desglyMidodrine, that is an alpha1-agonist, and exerts its actions via activation of the alpha-adrenergic receptors of the arteriolar and venous vasculature, producing an increase in vascular tone and elevation of blood pressure. DesglyMidodrine does not stimulate cardiac beta-adrenergic receptors. DesglyMidodrine diffuses poorly across the blood-brain barrier, and is therefore not associated with effects on the central nervous system.

Metabolite desglymidodrine

Metabolism

After oral administration, midodrine hydrochloride is rapidly absorbed. The plasma levels of the prodrug peak after about half an hour, and decline with a half-life of approximately 25 minutes, while the metabolite reaches peak blood concentrations about 1 to 2 hours after a dose of midodrine and has a half-life of about 3 to 4 hours. The absolute bioavailability of midodrine (measured as desglyMidodrine) is 93%.

Indications

Midodrine hydrochloride tablets are indicated for the treatment of symptomatic orthostatic hypotension. It has been suggested also as a treatment for chronic fatigue syndrome. ^[1]

Contraindications

Midodrine hydrochloride tablets are contraindicated in patients with severe organic heart disease, acute renal disease, urinary retention, pheochromocytoma or thyrotoxicosis. Midodrine hydrochloride should not be used in patients with persistent and excessive supine hypertension.

Side Effects

Headache; feeling of pressure/fullness in the head, vasodilation/flushing face, confusion/thinking abnormality, dry mouth; nervousness/anxiety and rash.

References

1. ^ Naschitz J, Dreyfuss D, Yeshurun D, Rosner I (April 2004). "Midodrine treatment for chronic fatigue syndrome". Postgrad Med J 80 (942): 230–2. doi:10.1136/pgmj.2003.011429. PMID 15082846. http://pmj.bmj.com/cgi/pmidlookup?view=long&pmid=15082846. 

External links

http://www.drugs.com/pro/midodrine.html

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COMT Inhibitors Entacapone • Tolcapone Others Precursors L-Phenylalanine → L-Tyrosine → L-DOPA (Levodopa) → Dopamine • L-DOPS (Droxidopa) Cofactors Ferrous Iron (Fe2+) • S-Adenosyl-L-Methionine • Vitamin B3 (Niacin, Nicotinamide → NADPH) • Vitamin B6 (Pyridoxine, Pyridoxamine, Pyridoxal → Pyridoxal Phosphate) • Vitamin B9 (Folic Acid → Tetrahydrofolic Acid) • Vitamin C (Ascorbic Acid) • Zinc (Zn2+) Others Activity Enhancers: Benzofuranylpropylaminopentane (BPAP) • Phenylpropylaminopentane (PPAP); Release Blockers: Bretylium • Guanethidine

v • d • e Cardiac stimulants excluding cardiac glycosides (C01C) Adrenergic and dopaminergic agents Adrenergic agonists α Metaraminol • Phenylephrine • Methoxamine • Norfenefrine • Oxedrine • Midodrine • Mephentermine β Dobutamine • Arbutamine • Isoprenaline • Prenalterol mixed Epinephrine # • Norepinephrine • Etilefrine Dopamine agonists Fenoldopam Both Dopamine # • Dopexamine • Ibopamine • Octopamine Unknown/ungrouped Dimetofrine • Gepefrine • Cafedrine • Theodrenaline Phosphodiesterase inhibitors (PDE3I) Amrinone • Milrinone • Enoximone • Bucladesine Other cardiac stimulants Angiotensinamide • Xamoterol • Levosimendan # = WHO-EM

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