Generality
Midodrine is an active ingredient used in the treatment of hypotension .
Midodrine is available in medicines suitable for oral administration ( oral tablets and drops) and for parenteral administration (solution for injection).
In truth, midodrine is a pro-drug, this means that the molecule becomes active and performs its therapeutic action only after metabolism.
More precisely, the active metabolite of midodrine is 1- (2, 5-dimethissophenyl) -2-aminoethanol, also known as desglimidodrina .
Examples of Medical Specialties containing Midodrine
- Gutron®
- Midodrina EG®
- Midodrina Union Health®
Curiosity
In August 2010, the FDA (Food and Drug Administration of United States) requested the withdrawal of midodrine-containing medicines from the market, since the post-approval studies necessary to verify the benefits of taking the drug were not carried out by the manufacturers . However, in September of the same year, this request was canceled by the FDA itself and the aforementioned studies started.
Therapeutic indications
When is the use of Midodrina indicated?
The use of midodrine is indicated for the treatment of hypotension (low blood pressure) in all the following cases:
- Essential hypotension;
- Orthostatic hypotension, a condition in which excessive drop in blood pressure causes a feeling of vertigo when one gets up;
- Hypotensive-asthenic syndrome (a disorder that occurs in particularly debilitated people);
- Hypotensive states that may occur following surgery (post-operative hypotension), following an infection (post-infectious hypotension) or following a pregnancy (postpartum hypotension);
- Hypotension due to climate change (based on climate);
- Hypotension caused by the use of psychotropic drugs.
Warnings
Warnings and precautions for the use of Midodrina
Before taking midodrine medicines, you should tell your doctor if you have diabetes, as you need to check your blood sugar levels frequently.
Furthermore, if the treatment with midodrine is continued for long periods of time, it is also necessary to perform periodic checks on the patient's renal function .
Please note
The use of midodrine-based medicines without therapeutic necessity constitutes doping ; moreover, the assumption of the active ingredient can determine positivity to doping tests even when used for the treatment of hypotension. Therefore, those who practice sports must pay attention.
Pharmacological Interactions
Interactions of Midodrine with Other Drugs
During midodrine therapy, it is advisable to avoid the concomitant use of monoamine oxidase inhibitors (MAOIs) used in the treatment of depressive disorders. This is because these drugs can enhance the action of midodrine, causing an excessive increase in blood pressure.
However, before taking midodrine, it is advisable to inform your doctor if you are taking - or have recently been - products of any kind, including over-the-counter drugs, medicines without a prescription (SOP drugs), phytotherapy and herbal products.
Side effects
Side Effects Caused by the Assumption of Midodrine
Like any other drug, midodrine can also cause side effects, although not all patients manifest them or manifest them in the same way. In fact, each individual reacts subjectively to the administration of the active ingredient in question.
However, among the side effects that may occur following the administration of midodrine, we find:
- dizziness;
- Dizziness;
- Tingling sensation localized, in particular, to the head and trunk.
The aforementioned side effects may occur one or two hours after the drug is given and can last for 3-5 hours.
Overdose
Taking excessive doses of midodrine can lead to the appearance of:
- Reflex bradycardia;
- Excessive increase in blood pressure;
- Pilomotor reactions (goose bumps);
- Headache;
- Increased urination stimulus;
- Palpitations;
- Cold sensation.
In the event of an overdose of midodrine - suspected or ascertained - it is necessary to immediately contact the doctor or go to the nearest hospital. Treatment is generally symptomatic and supportive and varies according to the type and severity of the symptoms manifested.
Action mechanism
How does Midodrina work?
As mentioned, midodrine is a pro-drug, which means that it is able to exert hypotensive action only after being metabolized.
In fact, midodrine consists of the union of two well-defined molecules: a catecholamine, that is 1 (2, 5-dimethoxyphenyl) -2-aminoethanol and an amino acid, glycine. Following metabolic reactions, the active metabolite 1- (2, 5-dimethoxyphenyl) -2-aminoethanol (desglimidodrina) is released and can exert therapeutic activity. In detail, this compound is a direct and selective agonist of peripheral alpha-adrenergic receptors located on blood vessels. Thanks to this characteristic, the active metabolite of midodrine induces an increase in venous and arteriolar tone which, in turn, progressively increases venous return to the heart, thereby promoting an increase in blood pressure.
Moreover, thanks to its selectivity towards alpha-adrenergic receptors, it does not interact with beta-adrenergic receptors, thus avoiding the appearance of side effects on the bronchi, heart and metabolism.
Method of use and Posology
How to Hire Midodrina
Midodrine is available both in pharmaceutical formulations suitable for oral administration - oral tablets and drops - and in pharmaceutical formulations suitable for parenteral administration - solution for injection.
Dose and frequency of midodrine administration should be established by the physician, on a strictly individual basis, for each patient. However, the usual dosage is as follows:
- Hypothetical states of live and medium entity : 1.75-2.5 mg of active ingredient up to three times a day.
- Severe hypotensive states and hypotensive states caused by the use of psychotropic drugs : 2.5-5 mg up to three times a day.
Oral drops can be taken as such, or diluted in water or on a sugar cube.
The tablets must be swallowed whole; while the solution for injection should be administered by specialized health personnel.
Pregnancy and breastfeeding
Can Midodrine be taken during pregnancy and during breastfeeding?
The use of midodrine during pregnancy and lactation should only take place if prescribed by your doctor and only if absolutely necessary.
In any case, future mothers and breastfeeding women should inform their doctor of their condition before taking any type of medication.
Contraindications
When Midodrine should not be used
The use of midodrine-containing medicines is contraindicated:
- In case of known allergy to the same midodrine or to any of the excipients contained in the medicinal product to be used;
- In patients suffering from arterial hypertension, cardiovascular and / or heart disease;
- In patients suffering from closed-angle glaucoma;
- In patients with pheochromocytoma;
- In patients suffering from benign prostatic hyperplasia;
- In patients with urination difficulties;
- In patients who have thyrotoxicosis.
