midodrine (ProAmatine, Gutron)

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Introduction

Tradename: ProAmantine.

Indications

Contraindications

pregnancy category = c

safety in lactation = ?

Dosage

Tabs: 2.5 mg, 5 mg.

Dosage adjustment in renal failure

  • start 2.5 mg PO BID
  • increase as necessary & tolerated

Pharmacokinetics

  • bioavailability of oral dose is 93%
  • midodrine is a prodrug
  • major active metabolite is desglymidodrine formed by deglycination of midodrine
  • plasma midodrine peaks 30 minutes after an oral dose with an elimination 1/2life of 25 minutes
  • desglymidodrine peaks in 1-2 hours
  • desglymidodrine elimination 1/2life of 3-4 hours
  • protein binding is minimal

elimination via liver

Monitor

renal function & hepatic function

Adverse effects

Drug interactions

Mechanism of action

More general terms

Additional terms

References

  1. Low et al JAMA 277:1046-51 1997
  2. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  3. PDR 56th edition, 2002
  4. Department of Veterans Affairs, VA National Formulary
  5. 5.0 5.1 5.2 FDA MedWatch [Posted 08/16/2010] Midodrine hydrochloride: FDA Proposes Withdrawal of Low Blood Pressure Drug http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm222640.htm
  6. Medical Knowledge Self Assessment Program (MKSAP) 18, American College of Physicians, Philadelphia 2018
  7. 7.0 7.1 7.2 Sheldon R, Faris P, Tang A et al. Midodrine for the prevention of vasovagal syncope: A randomized clinical trial. Ann Intern Med 2021 Aug 3; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34339231 https://www.acpjournals.org/doi/10.7326/M20-5415
    Brignole M. Establishing the efficacy of midodrine to prevent vasovagal syncope. Ann Intern Med 2021 Aug 3; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34339220 https://www.acpjournals.org/doi/10.7326/M21-2859
  8. 8.0 8.1 Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022

Database