Midodrine

The usual recommended starting dose of midodrine for adults is 2.5 mg 3 times daily, taken with or without food. Midodrine may also be taken as frequently as 6 times a day, as long as the maximum daily dose of 30 mg is not exceeded. The last midodrine dose of the day should be taken at least 4 hours before bedtime. People with Kidney Disease may need lower doses.

Midodrine will be started under close medical supervision, usually in a hospital, clinic, or doctor's office. Both lying and sitting blood pressures should be measured every hour for 3 hours after the first and second doses of midodrine therapy and also when there is an increase in dose. Thereafter, blood pressures should be measured daily for the first month, and then twice weekly while on therapy. Midodrine should only be continued if the person appears to have improvement in their symptoms during the initial treatment.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to use Midodrine exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue on with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store Midodrine at room temperature, protect it from light, and keep it away from heat and out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

In addition to its desired action, this medication may cause some adverse effects, notably: it may cause goose bumps; it may cause pain; it may cause numbness and a decreased sensitivity to touch; it may cause stinging or itching; it may cause difficulty in urination. Each person may react differently to a treatment. If you think this medication may be causing adverse effects (including those described here, or others), talk to your health care professional. He or she can help you to determine whether or not the medication is the source of the problem.

2.5 mg
Each white-to-off-white, round, scored tablet debossed with "H" above the score line and "P" below the score on one side and "504" on the other side, contains 2.5 mg of midodrine. Nonmedicinal ingredients: colloidal silicon dioxide, magnesium stearate, microcrystalline cellulose, and pregelatinized starch.

5 mg
Each light-orange-coloured, round, scored tablet debossed with "H" above the score and "P" below the score on one side and "505" on the other side, contains 5 mg of midodrine. Nonmedicinal ingredients: colloidal silicon dioxide, magnesium stearate, microcrystalline cellulose, pregelatinized starch and the colourant FD&C Yellow No. 6/Sunset Yellow FCF Aluminum Lake.

Do not use Midodrine if you:

• are allergic to midodrine or to any of the ingredients of the medication
• have a condition known as pheochromocytoma (a tumour of the adrenal gland)
• have acute kidney disease
• have high blood pressure
• have blood vessel disease that causes narrowing of blockage of blood vessels
• have narrow angle Glaucoma
• have an enlarged prostate
• have an overactive Thyroid
• have difficulty passing urine
• have persistent and excessive supine hypertension (high blood pressure when lying down)
• have severe heart disease

There may be an interaction between midodrine and any of the following:

• alpha-agonists (e.g., Clonidine, methyldopa)
• alpha-blockers (e.g., Alfuzosin, Doxazosin, Silodosin, Tamsulosin)
• Amiodarone
• amphetamines (e.g., Dextroamphetamine, Lisdexamfetamine)
• Atomoxetine
• beta-blockers (e.g., Atenolol, Metoprolol, Nadolol, Propranolol)
• Bromocriptine
• bronchodilators (e.g., formoterol, salbutamol, salmeterol, terbutaline)
• Cabergoline
• caffeine
• Ceritinib
• corticosteroids (e.g., cortisone, Fludrocortisone, Prednisone)
• decongestant cold medications (e.g., phenylephrine, Pseudoephedrine)
• decongestant eye drops and nose sprays (e.g., naphazoline, oxymetazoline, xylometazoline)
• dexmethylphenidate
• Digoxin
• Diltiazem
• dipivefrin
• Donepezil
• dopamine
• Dronedarone
• Epinephrine
• ergot alkaloids (e.g., ergotamine, Dihydroergotamine)
• Fingolimod
• Flecainide
• fingolimod
• Galantamine
• Guanfacine
• Linezolid
• procainamide
• Methylphenidate
• monoamine oxidase inhibitors (M.O.S. e.g., Moclobemide, Rasagiline, Selegiline, Tranylcypromine)
• Nabilone
• Octreotide
• Propafenone
• quinidine
• Rivastigmine
• somatostatin analogues (e.g., Lanreotide, octreotide, Pasireotide)
• tedizolid
• theophyllines (e.g., Aminophylline, Oxtriphylline, Theophylline)
• Tizanidine
• tricyclic antidepressants (e.g., Amitriptyline, Clomipramine, Desipramine, Trimipramine)
• Verapamil

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than the ones listed above may interact with Midodrine. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Midodrine.

Abnormal heart rhythms: If you have abnormal heart rhythms, discuss with your doctor how Midodrine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Midodrine, and whether any special monitoring is needed.

Bladder problems: Midodrine can cause urinary retention or worsen existing urinary retention. If you have bladder problems, discuss with your doctor how Midodrine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Midodrine, and whether any special monitoring is needed.

Diabetes: If you have diabetes and have experienced low blood pressure when rising from a sitting or lying position to a standing position, your doctor should closely monitor your condition while you are taking Midodrine.

Heart problems: Midodrine can cause slowing of your heartbeat. Report any slow heartbeat, increased dizziness, or fainting spells to your doctor immediately.

Kidney function: People with reduced kidney function do not clear midodrine from their bodies as quickly as people with regular kidney function. Lower doses of Midodrine and close monitoring by your doctor may be needed.

Liver function: If you have reduced liver function, discuss with your doctor how Midodrine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Midodrine, and whether any special monitoring is needed.

Supine hypertension: Midodrine can cause supine hypertension (high blood pressure when lying down), and persistently high supine blood pressure can lead to strokes, heart attacks, heart failure, and kidney problems. People on midodrine should have their supine (lying on the back) and sitting blood pressures monitored regularly. If you have symptoms of supine hypertension (such as pounding in the ears, headache, heartbeat awareness, or blurred vision), stop using midodrine and contact your doctor immediately.

Visual problems: If you have visual problems (e.g., glaucoma), discuss with your doctor how Midodrine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Midodrine, and whether any special monitoring is needed.

Pregnancy: Midodrine should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking Midodrine, contact your doctor immediately.

Breast-feeding: It is not known if midodrine passes into breast milk. If you are a breast-feeding mother and are taking Midodrine, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using Midodrine have not been established for children 12 years of age and younger.

This medication is typically used 3 times a day. However, your pharmacist may have suggested a different schedule that is more appropriate for you. Important: Follow the instructions on the label. Do not use more of this product, or more often, than prescribed. It must be used regularly and continuously to maintain its beneficial effects. Be sure to keep an adequate supply on hand. If you forget a dose, take it as soon as you remember -- unless it is almost time for your next dose. In that case, skip the missed dose. Do not double the next dose to catch up. This medication may be taken with or without food.