Midodrine

If you have low blood pressure, then I usually am starting a patient on metadrine or, you know, a medication that's going to increase their blood pressure.

I like Midodrine because it's short acting.

You can take it every four hours.

Sometimes you can even use it as needed.

Like let's say you know that you're going to be sitting in class for four hours.

You take it for class so you can keep your blood pressure up while you're sitting there.

Or if you're going to go exercise, you can take the Midodrine.

But oftentimes it really helps to take it every four hours during the day.

The adult study that reaches a three-month threshold is BEYOND 2017, comparing mitadrine, pyridostigmine, and a combination in neurogenic orthostatic hypotension.

Orthostatic blood pressure drops and symptoms improved, and Midodrine had better symptom improvement than Pyridostigmine, but it was open-label and classified as Class IV evidence.

So, for neurogenic orthostatic hypotension, the practical recommendation is…

Reasonable for severe, symptomatic neurogenic orthostatic hypotension after non-drug steps.

Review medications, hydration, and salt if appropriate, compression, positional strategies, head of bed elevation, and trigger avoidance.

Then use Midodrine with a clear target.

Fewer near syncopal episodes, standing long enough to shower, walking to meals, fewer falls, better function.

If you cannot name the functional target, you are probably treating the chart.

all that stuff.

And then I'll go to medicine, which would be Floraneth, Midodrine.

Those two are kind of the first line that I'll start with.

And then sometimes the two together, if they're still staying low and But the thing that we worry about is supine hypertension, that it helps them keep them up when they go from sitting to standing, but when they're lying down, their blood pressure is high.

I've also used pyridostigmine.

for orthostatic hypotension.

And I'll just make a note that Midodrine can worsen urinary retention, which has been an issue for some of my patients because they already have urinaries just

often.

The medical treatments we currently deploy, such as midodrine and octreotide, are purely temporizing measures.

What do they do?

Midodrine is a potent systemic alpha-1 agonist that forcibly vasoconstricts the systemic circulation trying to raise the blood pressure.

Octreotide inhibits the release of vasodilatory peptides, decreasing that massive splanchnic pooling.

So trying to force blood back to the kidneys?