Adult: For patients whose lives are considerably impaired despite standard clinical care, including non-pharmacologic therapy, plasma volume expansion or lifestyle changes: Initially, 2.5 mg tid preferably given during daytime hours (when the patient is upright). Dose may be gradually increased at weekly intervals according to response. Max: 10 mg tid. Avoid administration late in the evening; last daily dose must be taken at least 4 hours before bedtime. Dosage recommendations may vary among individual products and between countries (refer to detailed product guidelines).
What are the brands available for Midodrine in Hong Kong?
Gutron
Administration
Midodrine Should be taken with food.
Contraindications
Severe organic heart disease (e.g. bradycardia, ischaemic heart disease, MI, CHF, cardiac conduction disturbances or aortic aneurysm); supine hypertension, poorly controlled hypertension, phaeochromocytoma; serious obliterative or spastic vascular disorders (e.g. cerebrovascular occlusion and spasms); thyrotoxicosis, hyperthyroidism; proliferative diabetic retinopathy, narrow-angle glaucoma; urinary retention, acute renal disease. Contraindications may vary among countries and between individual products (refer to specific product guidelines).
Special Precautions
Patient with diabetes mellitus, visual problems (particularly when taking fludrocortisone); atherosclerotic disease (particularly with symptoms of intestinal angina or leg claudication), severe autonomic nervous system dysfunction; prostate disorders. Renal and hepatic impairment. Elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Supine hypertension, bradycardia, urinary retention. Gastrointestinal disorders: Nausea, dyspepsia, stomatitis, abdominal pain. General disorders and administration site conditions: Chills. Nervous system disorders: Headache, paraesthesia, scalp paraesthesia. Renal and urinary disorders: Dysuria. Skin and subcutaneous tissue disorders: Piloerection, pruritus, rash, scalp pruritus. Vascular disorders: Flushing.
Monitor renal and hepatic function before treatment initiation and regularly during treatment; supine, sitting and standing (upon awakening) blood pressure regularly. Assess for signs and symptoms of supine hypertension and bradycardia.
Overdosage
Symptoms: Hypertension, bradycardia, piloerection, feeling cold, and urinary retention. Management: May consider inducing emesis or giving α-sympatholytic drugs (e.g. phentolamine, nitroprusside). Administer atropine to block bradycardia or bradycardic conduction disturbances.
Drug Interactions
Increased risk of hypertension with sympathomimetics and vasoconstrictive agents (e.g. reserpine, guanethidine, TCAs, phenyleprine, ephedrine, dihydroergotamine, phenylpropanolamine, pseudoephedrine, thyroid hormones, antihistamines, MAOIs). May potentiate bradycardic effect with cardiac glycosides (e.g. digoxin), β-blockers, and other agents that directly or indirectly decrease heart rate. May increase the hypertensive effects of corticosteroids (e.g. fludrocortisone). Therapeutic effects may be antagonised by α-adrenergic blockers (e.g. prazosin, terazosin).
Action
Description: Mechanism of Action: Midodrine is a prodrug converted to the active desglymidodrine metabolite, a direct sympathomimetic agent with selective α1-agonist effect. Desglymidodrine activates the α1-adrenergic receptors of the arteriolar and venous vasculature, resulting in increased vascular tone and elevation of blood pressure. It does not stimulate cardiac β-adrenergic receptors. Onset: Approx 1 hour. Duration: 2-3 hours. Pharmacokinetics: Absorption: Rapidly absorbed from the gastrointestinal tract. Bioavailability: 93% (desglymidodrine). Time to peak plasma concentration: 30 minutes (midodrine); 1-2 hours (desglymidodrine). Distribution: Poorly crosses the blood-brain barrier. Metabolism: Metabolised in the liver and many other tissues via rapid deglycination into the active metabolite, desglymidodrine. Excretion: Via urine (80% as desglymidodrine). Elimination half-life: Approx 25 minutes (midodrine); approx 3-4 hours (desglymidodrine).
Chemical Structure
Midodrine Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 4195, Midodrine. https://pubchem.ncbi.nlm.nih.gov/compound/Midodrine. Accessed May 28, 2025.
C01CA17 - midodrine ; Belongs to the class of adrenergic and dopaminergic cardiac stimulants excluding glycosides. Used in the treatment of hypotension.
References
Brayfield A, Cadart C (eds). Midodrine Hydrochloride. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 11/04/2025.Douglas Pharmaceuticals Ltd. Gutron 2.5 and 5 mg Tablet data sheet 05 November 2021. Medsafe. http://www.medsafe.govt.nz. Accessed 11/04/2025.Joint Formulary Committee. Midodrine Hydrochloride. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 11/04/2025.Midodrine Hydrochloride 5 mg Tablets (Morningside Healthcare Ltd). MHRA. https://products.mhra.gov.uk. Accessed 11/04/2025.Midodrine Hydrochloride Tablet (Endo USA, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 11/04/2025.Midodrine. UpToDate Lexidrug, AHFS DI (Adult and Pediatric) Online. American Society of Health-System Pharmacists, Inc. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 11/04/2025.Midodrine. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 11/04/2025.Miron 2.5 mg, 5 mg and 10 mg Tablets (Novugen Pharma Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 11/04/2025.
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