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Midodrine 5mg Tablets – Summary of Product Characteristics (SmPC)

This information is intended for use by health professionals

Each tablet contains 5 mg midodrine hydrochloride.

Excipients with known effect:

Each tablet contains 0.1 mg Sunset Yellow FCF aluminium lake (E110).

For the full list of excipients, see section 6.1

Light orange coloured, round, scored tablets debossed with ‘H’ above the score and ‘P’ below the score on one side and ‘505’ on the other side. The diameter of the tablet is 7.10 mm ±0.2 mm.

The tablet can be divided into equal doses.

For use in the treatment of severe orthostatic hypotension due to dysfunction of the autonomic nervous system when corrective factors have been ruled out.

Posology:

The usual initial dosage is 2.5 mg of midodrine hydrochloride 2-3 times daily. The dose should be increased at weekly intervals in small increments until an optimal response is obtained. The maintenance dosage should be determined individually for each patient to achieve optimal therapeutic effect while reducing the impact of adverse reactions.

The maximum daily dosage is 30 mg midodrine hydrochloride, divided into 3 single doses and this limit can be exceeded only in exceptional cases.

Midodrine 5 mg tablets should be taken during daytime when the patient performs his daily activities in upright position. A dosing schedule of 3-4 hour intervals is suggested. The last dose should be taken at least four hours before bedtime to reduce the risk of supine hypertension. Blood pressure in supine and sitting position should be regularly monitored at the beginning of the treatment (at least twice a week). Treatment with Midodrine 2.5 mg tablets should be stopped if supine hypertension is significantly excessive.

Midodrine 5 mg tablets should be taken with sufficient amount of fluid. They can be taken during meal time. The duration of treatment is based on the progression of the disease.

Special populations

Pediatric population

Not recommended for children.

Elderly patients

Although there is no evidence to suggest that dosage requirements are different in the elderly, it is recommended that the initial dose used be small and that increases in dosage be titrated against the patients’ clinical condition with caution.

The administration of midodrine should be stopped and the attending physician notified immediately if the blood pressure in either position increases above 180/100 or is considered clinically significant.

Patients with renal impairment

No specific studies addressing a possible dose-reduction have been performed in patients with renal insufficiency. Generally, Midodrine is contraindicated in patients with acute renal disease and severe renal insufficiency (see section 4.3).

Patients with hepatic impairment

No specific studies have been performed in this patient population.

• Hypersensitivity to the active substance or to any of the excipients listed in section 6.1

• Hypertension

• Severe organic heart disease or congestive heart failure

• Thyrotoxicosis

• Pheochromocytoma

• Acute nephritis

• Acute renal disease

• Severe renal insufficiency (creatinine clearance <30 ml/min)

• Hypertrophy of the prostate gland with residual urine volume increased

• Proliferative diabetic retinopathy

• Urinary retention

• Hyperthyroidism

• Narrow angle glaucoma

• Obliterative or spastic vessel disease (e.g. cerebrovascular occlusions and spasms)

• Vasovagal hypotension

Regular monitoring of blood pressure in supine and sitting position is required during treatment with midodrine tablets. Patients with diabetes mellitus who show high blood pressure levels in supine position due to underlying neurological disorders (diabetic autonomic neuropathy) may suffer from supine hypertension with midodrine tablets. Hence, special caution is recommended.

Any possible danger to the patients should be ruled out before starting treatment with midodrine tablets. The patients should be informed to report any symptoms of supine hypertension such as palpitations, headaches, blurred vision to the attending physician and the patient should be advised to discontinue the medication immediately.

The dosage should be adjusted in this case or treatment with midodrine hydrochloride should be terminated. Supine hypertension may also be controlled by elevation of the head.

The treatment should not be continued in patients suffering from severely fluctuating blood pressure with midodrine tablets.

Patients taking midodrine should avoid concomitant use of other adreno-sympathomimetic drugs including over the counter remedies (see 4.5).

Slowing of the heart rate may occur after administration of midodrine, primarily due to vagal reflex, therefore great caution should be taken when using it together with other agents that directly or indirectly slow the heart rate (see also section 4. 5) e.g. digitalis, beta blockers, psychopharmacologic agents (specifically tricyclic antidepressants, phenothiazines and atypical antipsychotics). Patients experiencing any signs or symptoms suggestive of bradycardia (pulse slowing, increased dizziness, syncope, cardiac awareness) should be advised to discontinue midodrine.

The use of midodrine in patients who have an increased risk of or suffer from glaucoma / increased intra-ocular pressure or who are treated with mineralocorticoids / fludrocortisone acetate (which may increase intra-ocular pressure) should be avoided or monitored very closely.

It is advisable to monitor the renal function and blood pressure in case of long-term treatment with midodrine tablets. Sufficient data is not available for patients with hepatic impairment. Therefore, it is advisable to monitor the liver function before and during treatment with midodrine tablets.

Midodrine hydrochloride is a cytochrome P450 CYP2D6 inhibitor and can therefore influence the metabolism of other medicines (eg. , Perphenazine, Amiodarone, Metoclopramide), which are metabolized through this cytochrome 450 isoenzyme. This may lead to increased systemic exposure and increased effects of this medicinal product.

Tricyclic antidepressants, alpha-sympathomimetic medicines, thyroid hormones, antihistamines, MAO inhibitor,

Enhanced sympathomimetic activity (undesired high blood pressure increase). Simultaneous usage is not recommended.

Alpha and beta receptor blockers

The effect of increased blood pressure of Midodrine hydrochloride can be antagonised by alpha receptor blocker (e.g. Prazosin or Phentolamine). The cardiac frequency reducing effect of beta blockers can be potentiated by midodrine hydrochloride.

The concomitant use of alpha- and beta-receptor blocking agents (which reduce the heart rate and midodrine requires careful monitoring.

Cardiac glycosides

The reflex bradycardia of midodrine hydrochloride may be increased by bradycardiac effect of glycosides. Therefore, simultaneous usage is not recommended.

Ergot alkaloid

Deterioration of peripheral blood circulation.

The patient may experience an increase in blood pressure and reduced blood flow to organs and hands/feet.

Avoid concomitant use of drugs that increase blood pressure. If concomitant use cannot be avoided, the blood pressure is to be monitored closely.

Corticosteroid preparations

Patients being treated with midodrine in combination with, mineralocorticoids or glucocorticoids (e. g. fludrocortisone) may be at increased risk of glaucoma/increased intraocular pressure, and should be carefully monitored. Midodrine may enhance or potentiate the possible hypertensive effect of corticosteroid preparations.

There are no data from the use of midodrine in pregnant women. Animal studies have shown reproductive toxicity (see section 5.3).

Midodrine is not recommended during pregnancy and in women of childbearing potential not using contraception. Any woman becoming pregnant during treatment should be withdrawn from the treatment immediately upon established pregnancy.

Breast-feeding

It is unknown whether midodrine/metabolites are excreted in human milk. A risk to the newborns/infants cannot be excluded. Midodrine should not be used during breast-feeding.

Patients who experience dizziness or light headedness while receiving Midodrine should refrain from operating machinery.

The following frequency categories are used for the evaluation of side-effects:

Very common

(≥ 1/10)

Common

(≥ 1/100 to < 1/10)

Uncommon

(≥ 1/1000 to < 1/100)

Rare

(≥ 1/10000 to < 1/1000)

Very rare

(< 1/10000)

Not known

frequency cannot be estimated based on the available data

System organ class

Very common

Common

Uncommon

Rare

Very rare

Unknown

Psychiatric disorders

Sleep disorders, insomnia

Anxiety, confusional state

Nervous system disorders

Paraesthesia

Headaches, restlessness, excitability, irritation

Dizziness or light headedness

Eye disorders

Visual disturbance

Increased tear production

Cardiac disorders

Reflex bradycardia, palpitations, ventricular arrhythmia, tachycardia

Chest pain

Vascular disorders

Supine hypertension (blood pressure ≥ 180/110 mmHg) with daily doses of more than 30 mg

Supine hypertension (blood pressure ≥ 180/110 mmHg) with daily doses up to 7. 5 mg

Cerebrovascular accident

Gastrointestinal disorders

Nausea, vomiting, stomatitis dyspepsia

Abdominal pain

Diarrhoea

Hepatobiliary disorders

Hepatic function abnormal, increased liver enzyme

Skin and subcutaneous tissue disorders

Piloerection (goose bumps),

Chills, skin rash, pruritus (mainly of the scalp), flushing

Renal and urinary disorders

Dysuria

Urinary retention

Urinary urgency

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continuous monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme Website: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store

Overdosage of midodrine produces piloerection, sensation of coldness, an urgent desire to empty the bladder, hypertension and bradycardia.

These effects can be counteracted by induced emesis and administration of alpha-sympatholytic drugs. In marked bradycardia, atropine may be given at its usual dose. In exanthema, H-1 antihistamines should be administered.

The active metabolite desglymidodrine is dialysable.

Pharmacotherapeutic group: Cardiac stimulants, excluding cardiac glycoside.

ATC-Code: C01CA17

Mechanism of action

The alpha sympathomimetic drug midodrine hydrochloride is a prodrug, which is converted to its pharmacologically active metabolite desglymidodrine in various tissues.

Pharmacodynamic reactions

Desglymidodrine is a selective alpha-1-adrenoreceptor agonist. Its effect on cardiac circulation system is mainly due to increase of systolic and diastolic blood pressure. This increase in blood pressure occurs due to arterial and venous vasoconstriction. Midodrine hydrochloride triggers alpha receptors at the bladder, which in turn is connected with increase of tone at bladder exit and delayed emptying of the bladder.

Absorption

After oral administration of a dose of 2.5 mg, midodrine hydrochloride is rapidly and completely absorbed and reaches its peak plasma concentrations after approximately 20-30 minutes (Cmax approx. 0.01 mg/l, tmax < 30 min). The prodrug midodrine hydrochloride is converted in different tissues (also in liver) enzymatically into its active metabolite desglymidodrine. The absolute bioavailability of midodrine hydrochloride (and desglymidodrine) amounts to 93% after oral administration.

AUC and Cmax increase proportionally to the doses in a dosage range of 2.5 – 22.5 mg. Administration with food increases the AUC by approximately 25%, and the Cmax decreases by approximately 30%. The pharmacokinetics of desglymidodrine is not affected.

After oral administration of a dosage of 5 – 10 mg of midodrine hydrochloride in fasting patients with orthostatic hypertension, desglymidodrine reaches its highest plasma concentration (0.027 mg/l) approx. 1h after oral administration (tmax = 1.1 h) and after intravenous injection within a period of 60 – 120 min.

Distribution

The distribution of midodrine in humans was not analysed.

Midodrine and desglymidodrine bind less than 30% to plasma proteins. Studies on animals show that desglymidodrine is distributed in the target organs. The distribution of midodrine in humans has not been established, it does not appear to cross the blood-brain barrier after oral administration.

Biotransformation

This medicinal product is split into its pharmacologically active metabolite desglymidodrine through enzymatic degradation in different tissues (including liver).

Elimination

Midodrine hydrochloride is quickly eliminated from plasma (t1/2 = 0.41 – 0.49 h), and desglymidodrine is eliminated somewhat slowly (t1/2 = 3 h).

Midodrine hydrochloride and desglymidodrine are almost completely (91%) eliminated renally within 24 hours (approx. 40 – 60% as active metabolite, 2 – 5% as non-metabolised midodrine hydrochloride, the rest as other pharmacologically inactive metabolites). The elimination of midodrine hydrochloride or desglymidodrine through faeces is negligible. After intravenous administration, 53% of applied quantity was eliminated in the first 4 hours and 47% through urine after peroral administration. The faecal elimination is 2.1%.

Special populations

To date there are no pharmacological data about midodrine or its metabolites desglymidodrine in older patients or patients with renal and/or liver function disorders.

Non-clinical data revealed no special hazard for humans based on conventional studies of safety pharmacology and repeated dose toxicity.

Reproduction toxicity

Studies in rats and rabbits have shown embryotoxicity, but no teratogenic effects are reported.

Genotoxicity

In-vitro and in-vivo studies for midodrine hydrochloride did not show any indication of mutagenic or genotoxic potential.

Carcinogenicity

Increased tumour incidence in the testicular interstitial cells was observed in carcinogenicity studies. The relevance of this observation for humans is not clear.

Hydrophobic Colloidal anhydrous Silica

Microcrystalline cellulose

Pregelatinized Starch

Magnesium stearate

Sunset yellow FCF-Lake (E110)

As packaged for sale: 2 years

For HDPE bottle after first opening: 100 days.

For HDPE bottle pack: This medicinal product does not require any special storage condition.

For blister pack: Store below 25°C

Midodrine 5 mg tablets are available in pack sizes containing 100 x 1 tablets in PVC/PVDC/Aluminium perforated unit dose blisters.

It is also available in High Density Polyethylene (HDPE) bottle pack with 100 tablets.

Tillomed Laboratories Limited

220 Butterfield, Great Marlings

Luton, LU2 8DL

United Kingdom

Midodrine tablets

What is this medicine?

MIDODRINE (MI doe dreen) is used to treat low blood pressure in patients who have symptoms like dizziness when going from a sitting to a standing position.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

COMMON BRAND NAME(S): Orvaten, ProAmatine

What should I tell my health care provider before I take this medicine?

They need to know if you have any of the following conditions:

  • difficulty passing urine
  • heart disease
  • high blood pressure
  • kidney disease
  • over active thyroid
  • pheochromocytoma
  • an unusual or allergic reaction to midodrine, other medicines, foods, dyes, or preservatives
  • pregnant or trying to get pregnant
  • breast-feeding

How should I use this medicine?

Take this medicine by mouth with a glass of water. Follow the directions on the prescription label. The last dose of this medicine should not be taken after the evening meal or less than 4 hours before bedtime. When you lie down for any length of time after taking this medicine, high blood pressure can occur. Do not take this medicine if you will be lying down for any length of time. Do not take your medicine more often than directed. Do not stop taking except on your doctor’s advice.

Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

What may interact with this medicine?

Do not take this medicine with any of the following medications:

  • MAOIs like Carbex, Eldepryl, Marplan, Nardil, and Parnate
  • medicines called ergot alkaloids
  • medicines for colds and breathing difficulties or weight loss
  • procarbazine

This medicine may also interact with the following medications:

  • cimetidine
  • digoxin
  • flecainide
  • fludrocortisone
  • metformin
  • procainamide
  • quinidine
  • ranitidine
  • triamterene
  • medicines called alpha-blockers like doxazosin, prazosin, and terazosin

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medicine?

Visit your doctor or health care professional for regular checks on your progress.

You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how this medicine affects you. Do not stand or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells.

Your mouth may get dry. Chewing sugarless gum or sucking hard candy, and drinking plenty of water may help. Contact your doctor if the problem does not go away or is severe.

Do not treat yourself for coughs, colds, or pain while you are taking this medicine without asking your doctor or health care professional for advice. Some ingredients may increase your blood pressure.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:

  • awareness of heart beating
  • blurred vision
  • headache
  • irregular heartbeat, palpitations, or chest pain
  • pounding in the ears
  • skin rash, hives

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

  • change in heart rate
  • chills
  • goose bumps
  • increased need to urinate
  • itching
  • stomach pain
  • tingling in the skin or scalp

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medicine?

Keep out of the reach of children.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Throw away any unused medicine after the expiration date.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.

ProAmatine, Orvaten (midodrine) dosing, indications, interactions, adverse effects, and more

  • albuterol

    Monitor Closely (2)albuterol and midodrine both decrease sedation. Use Caution/Monitor.

    albuterol and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • alfentanil

    Monitor Closely (1)alfentanil increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • alprazolam

    Monitor Closely (1)alprazolam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • amiodarone

    Monitor Closely (1)amiodarone will increase the level or effect of midodrine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.

  • amitriptyline

    Monitor Closely (1)amitriptyline increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious – Use Alternative (1)amitriptyline, midodrine. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

  • amobarbital

    Monitor Closely (1)amobarbital increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • amoxapine

    Monitor Closely (1)amoxapine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious – Use Alternative (1)amoxapine, midodrine. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

  • arformoterol

    Monitor Closely (2)arformoterol and midodrine both decrease sedation. Use Caution/Monitor.

    arformoterol and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • aripiprazole

    Monitor Closely (1)aripiprazole increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • armodafinil

    Monitor Closely (1)armodafinil and midodrine both decrease sedation. Use Caution/Monitor.

  • atomoxetine

    Monitor Closely (1)atomoxetine, midodrine. Other (see comment). Use Caution/Monitor.
    Comment: Due to the potential for increases in blood pressure and heart rate, atomoxetine should be used cautiously with vasopressors such as midodrine.

  • azelastine

    Monitor Closely (1)azelastine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • belladonna and opium

    Monitor Closely (1)belladonna and opium increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • benperidol

    Monitor Closely (1)benperidol increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • benzphetamine

    Monitor Closely (2)benzphetamine and midodrine both decrease sedation. Use Caution/Monitor.

    benzphetamine and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • bromocriptine

    Monitor Closely (1)bromocriptine, midodrine.
    Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Hypertension, V tach.

  • brompheniramine

    Monitor Closely (1)brompheniramine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • buprenorphine buccal

    Monitor Closely (1)buprenorphine buccal increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • butabarbital

    Monitor Closely (1)butabarbital increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • butalbital

    Monitor Closely (1)butalbital increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • butorphanol

    Monitor Closely (1)butorphanol increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • cabergoline

    Serious – Use Alternative (1)cabergoline, midodrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

  • caffeine

    Monitor Closely (1)caffeine and midodrine both decrease sedation. Use Caution/Monitor.

  • carbinoxamine

    Monitor Closely (1)carbinoxamine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • chloral hydrate

    Monitor Closely (1)chloral hydrate increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • chlordiazepoxide

    Monitor Closely (1)chlordiazepoxide increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • chlorpheniramine

    Monitor Closely (1)chlorpheniramine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • chlorpromazine

    Monitor Closely (2)chlorpromazine, midodrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

    chlorpromazine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • cimetidine

    Monitor Closely (1)cimetidine will increase the level or effect of midodrine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.

  • cinnarizine

    Monitor Closely (1)cinnarizine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • clemastine

    Monitor Closely (1)clemastine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • clomipramine

    Monitor Closely (1)clomipramine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious – Use Alternative (1)clomipramine, midodrine. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

  • clonazepam

    Monitor Closely (1)clonazepam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • clorazepate

    Monitor Closely (1)clorazepate increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • clozapine

    Monitor Closely (1)clozapine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • codeine

    Monitor Closely (1)codeine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • cyclizine

    Monitor Closely (1)cyclizine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • cyproheptadine

    Monitor Closely (1)cyproheptadine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • desflurane

    Serious – Use Alternative (1)desflurane increases toxicity of midodrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

  • desipramine

    Monitor Closely (1)desipramine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious – Use Alternative (1)desipramine, midodrine. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

  • desmopressin

    Minor (1)desmopressin increases effects of midodrine by pharmacodynamic synergism. Minor/Significance Unknown.

  • dexchlorpheniramine

    Monitor Closely (1)dexchlorpheniramine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • dexfenfluramine

    Monitor Closely (2)dexfenfluramine and midodrine both decrease sedation. Use Caution/Monitor.

    dexfenfluramine and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • dexmedetomidine

    Monitor Closely (1)dexmedetomidine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • dexmethylphenidate

    Monitor Closely (2)dexmethylphenidate and midodrine both decrease sedation. Use Caution/Monitor.

    dexmethylphenidate and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • dextroamphetamine

    Monitor Closely (2)dextroamphetamine and midodrine both decrease sedation. Use Caution/Monitor.

    dextroamphetamine and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • dextromoramide

    Monitor Closely (1)dextromoramide increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • diamorphine

    Monitor Closely (1)diamorphine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • diazepam

    Monitor Closely (1)diazepam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • diethylpropion

    Monitor Closely (2)diethylpropion and midodrine both decrease sedation. Use Caution/Monitor.

    diethylpropion and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • difenoxin hcl

    Monitor Closely (1)difenoxin hcl increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • digoxin

    Monitor Closely (1)digoxin will increase the level or effect of midodrine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.

  • dihydroergotamine

    Serious – Use Alternative (1)dihydroergotamine, midodrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

  • dihydroergotamine intranasal

    Serious – Use Alternative (1)dihydroergotamine intranasal, midodrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

  • dimenhydrinate

    Monitor Closely (1)dimenhydrinate increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • diphenhydramine

    Monitor Closely (1)diphenhydramine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • diphenoxylate hcl

    Monitor Closely (1)diphenoxylate hcl increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • dipipanone

    Monitor Closely (1)dipipanone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • dobutamine

    Monitor Closely (2)dobutamine and midodrine both decrease sedation. Use Caution/Monitor.

    dobutamine and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • dofetilide

    Monitor Closely (1)dofetilide will increase the level or effect of midodrine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.

  • dopamine

    Monitor Closely (2)dopamine and midodrine both decrease sedation. Use Caution/Monitor.

    dopamine and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • dopexamine

    Monitor Closely (2)dopexamine and midodrine both decrease sedation. Use Caution/Monitor.

    dopexamine and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • doxapram

    Serious – Use Alternative (1)doxapram increases effects of midodrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

  • doxepin

    Monitor Closely (1)doxepin increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious – Use Alternative (1)doxepin, midodrine. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

  • droperidol

    Monitor Closely (1)droperidol increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • droxidopa

    Monitor Closely (1)midodrine and droxidopa both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. May increase risk for supine hypertension

  • ephedrine

    Monitor Closely (3)ephedrine, midodrine.
    Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

    ephedrine and midodrine both decrease sedation. Use Caution/Monitor.

    ephedrine and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • epinephrine

    Monitor Closely (2)epinephrine and midodrine both decrease sedation. Use Caution/Monitor.

    epinephrine and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • epinephrine racemic

    Monitor Closely (2)epinephrine racemic and midodrine both decrease sedation. Use Caution/Monitor.

    epinephrine racemic and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • ergoloid mesylates

    Serious – Use Alternative (1)ergoloid mesylates, midodrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

  • ergotamine

    Serious – Use Alternative (1)ergotamine, midodrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

  • estazolam

    Monitor Closely (1)estazolam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • ethanol

    Monitor Closely (1)ethanol increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • ether

    Serious – Use Alternative (1)ether increases toxicity of midodrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

  • eucalyptus

    Minor (1)eucalyptus increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

  • fenfluramine

    Monitor Closely (2)fenfluramine and midodrine both decrease sedation. Use Caution/Monitor.

    fenfluramine and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • fluphenazine

    Monitor Closely (2)fluphenazine, midodrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

    fluphenazine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • flurazepam

    Monitor Closely (1)flurazepam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • formoterol

    Monitor Closely (2)formoterol and midodrine both decrease sedation. Use Caution/Monitor.

    formoterol and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • haloperidol

    Monitor Closely (1)haloperidol increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • hydralazine

    Monitor Closely (1)hydralazine, midodrine. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Sympathomimetics can antagonize the activity of some antihypertensive agents.

  • hydrochlorothiazide

    Minor (1)hydrochlorothiazide will increase the level or effect of midodrine by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

  • hydromorphone

    Monitor Closely (1)hydromorphone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • hydroxyzine

    Monitor Closely (1)hydroxyzine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • iloperidone

    Monitor Closely (1)iloperidone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • imipramine

    Monitor Closely (1)imipramine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious – Use Alternative (1)imipramine, midodrine. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

  • isocarboxazid

    Contraindicated (1)isocarboxazid increases effects of midodrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

  • isoflurane

    Serious – Use Alternative (1)isoflurane increases toxicity of midodrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

  • isoproterenol

    Monitor Closely (2)isoproterenol and midodrine both decrease sedation. Use Caution/Monitor.

    isoproterenol and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • ketotifen, ophthalmic

    Monitor Closely (1)ketotifen, ophthalmic increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • levalbuterol

    Monitor Closely (2)levalbuterol and midodrine both decrease sedation. Use Caution/Monitor.

    levalbuterol and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • levorphanol

    Monitor Closely (1)levorphanol increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • linezolid

    Contraindicated (1)linezolid increases effects of midodrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

  • lisdexamfetamine

    Monitor Closely (2)lisdexamfetamine and midodrine both decrease sedation. Use Caution/Monitor.

    lisdexamfetamine and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • lofepramine

    Monitor Closely (1)lofepramine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious – Use Alternative (1)lofepramine, midodrine. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

  • lofexidine

    Monitor Closely (1)lofexidine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • loprazolam

    Monitor Closely (1)loprazolam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • lorazepam

    Monitor Closely (1)lorazepam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • lormetazepam

    Monitor Closely (1)lormetazepam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • loxapine

    Monitor Closely (1)loxapine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • loxapine inhaled

    Monitor Closely (1)loxapine inhaled increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • maprotiline

    Monitor Closely (1)maprotiline increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious – Use Alternative (1)maprotiline, midodrine. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

  • marijuana

    Monitor Closely (1)marijuana increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • melatonin

    Monitor Closely (1)melatonin increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • memantine

    Minor (1)memantine will increase the level or effect of midodrine by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

  • meperidine

    Monitor Closely (1)meperidine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • meprobamate

    Monitor Closely (1)meprobamate increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • metaproterenol

    Monitor Closely (2)metaproterenol and midodrine both decrease sedation. Use Caution/Monitor.

    metaproterenol and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • metaxalone

    Monitor Closely (1)metaxalone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • metformin

    Minor (1)metformin will increase the level or effect of midodrine by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

  • methadone

    Monitor Closely (1)methadone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • methamphetamine

    Monitor Closely (2)methamphetamine and midodrine both decrease sedation. Use Caution/Monitor.

    methamphetamine and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • methoxyflurane

    Serious – Use Alternative (1)methoxyflurane increases toxicity of midodrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

  • methyclothiazide

    Minor (1)methyclothiazide will increase the level or effect of midodrine by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

  • methyldopa

    Monitor Closely (1)methyldopa increases effects of midodrine by unknown mechanism. Use Caution/Monitor.

  • methylenedioxymethamphetamine

    Monitor Closely (2)methylenedioxymethamphetamine and midodrine both decrease sedation. Use Caution/Monitor.

    methylenedioxymethamphetamine and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • methylergonovine

    Serious – Use Alternative (1)methylergonovine, midodrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

  • midazolam

    Monitor Closely (1)midazolam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • mirtazapine

    Monitor Closely (1)mirtazapine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • modafinil

    Monitor Closely (1)modafinil and midodrine both decrease sedation. Use Caution/Monitor.

  • morphine

    Monitor Closely (1)morphine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • motherwort

    Monitor Closely (1)motherwort increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • moxonidine

    Monitor Closely (1)moxonidine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • nabilone

    Monitor Closely (1)nabilone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • nalbuphine

    Monitor Closely (1)nalbuphine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • norepinephrine

    Monitor Closely (2)norepinephrine and midodrine both decrease sedation. Use Caution/Monitor.

    norepinephrine and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • nortriptyline

    Monitor Closely (1)nortriptyline increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious – Use Alternative (1)nortriptyline, midodrine. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

  • ofloxacin

    Minor (1)midodrine will increase the level or effect of ofloxacin by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

  • olanzapine

    Monitor Closely (1)olanzapine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • opium tincture

    Monitor Closely (1)opium tincture increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • oxazepam

    Monitor Closely (1)oxazepam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • oxycodone

    Monitor Closely (1)oxycodone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • oxymetazoline topical

    Monitor Closely (1)oxymetazoline topical and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • oxymorphone

    Monitor Closely (1)oxymorphone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • oxytocin

    Monitor Closely (1)oxytocin increases effects of midodrine by pharmacodynamic synergism. Use Caution/Monitor.

  • paliperidone

    Monitor Closely (1)paliperidone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • papaveretum

    Monitor Closely (1)papaveretum increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • pentazocine

    Monitor Closely (1)pentazocine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • pentobarbital

    Monitor Closely (1)pentobarbital increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • perphenazine

    Monitor Closely (2)perphenazine, midodrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

    perphenazine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • phendimetrazine

    Monitor Closely (2)midodrine and phendimetrazine both decrease sedation. Use Caution/Monitor.

    midodrine and phendimetrazine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • phenelzine

    Contraindicated (1)phenelzine increases effects of midodrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

  • phenobarbital

    Monitor Closely (1)phenobarbital increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • phentermine

    Monitor Closely (2)phentermine and midodrine both decrease sedation. Use Caution/Monitor.

    midodrine and phentermine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • phenylephrine

    Monitor Closely (2)midodrine and phenylephrine both decrease sedation. Use Caution/Monitor.

    midodrine and phenylephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • phenylephrine PO

    Monitor Closely (2)midodrine and phenylephrine PO both decrease sedation. Use Caution/Monitor.

    midodrine and phenylephrine PO both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • pholcodine

    Monitor Closely (1)pholcodine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • pimozide

    Monitor Closely (1)pimozide increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • pirbuterol

    Monitor Closely (2)pirbuterol and midodrine both decrease sedation. Use Caution/Monitor.

    pirbuterol and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • primidone

    Monitor Closely (1)primidone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • procainamide

    Monitor Closely (1)midodrine will increase the level or effect of procainamide by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.

  • procarbazine

    Serious – Use Alternative (1)procarbazine increases effects of midodrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of acute hypertensive episode.

  • prochlorperazine

    Monitor Closely (2)prochlorperazine, midodrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

    prochlorperazine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • promazine

    Monitor Closely (1)promazine, midodrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

  • promethazine

    Monitor Closely (2)promethazine, midodrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

    promethazine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • propofol

    Monitor Closely (1)propofol increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • propylhexedrine

    Monitor Closely (2)midodrine and propylhexedrine both decrease sedation. Use Caution/Monitor.

    midodrine and propylhexedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • protriptyline

    Monitor Closely (1)protriptyline increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious – Use Alternative (1)protriptyline, midodrine. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

  • pseudoephedrine

    Monitor Closely (1)midodrine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • quazepam

    Monitor Closely (1)quazepam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • quetiapine

    Monitor Closely (1)quetiapine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • quinidine

    Monitor Closely (1)quinidine will increase the level or effect of midodrine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.

  • quinine

    Minor (1)midodrine will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

  • rasagiline

    Serious – Use Alternative (1)rasagiline increases effects of midodrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Midodrine should not be given concurrently with monoamine oxidase inhibitors (MAOIs). Risk of acute hypertensive episode.

  • risperidone

    Monitor Closely (1)risperidone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • safinamide

    Monitor Closely (1)midodrine and safinamide both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Monitor patients for hypertension if safinamide is prescribed concomitantly with prescription or nonprescription sympathomimetics, including nasal, oral, or ophthalmic decongestants and cold remedies.

  • sage

    Minor (1)sage increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

  • salmeterol

    Monitor Closely (2)salmeterol and midodrine both decrease sedation. Use Caution/Monitor.

    salmeterol and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • scullcap

    Monitor Closely (1)scullcap increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • secobarbital

    Monitor Closely (1)secobarbital increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • selegiline

    Serious – Use Alternative (1)selegiline increases effects of midodrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Midodrine should not be given concurrently with monoamine oxidase inhibitors (MAOIs). Risk of acute hypertensive episode.

  • selegiline transdermal

    Contraindicated (1)selegiline transdermal increases effects of midodrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

  • sevoflurane

    Serious – Use Alternative (1)sevoflurane increases toxicity of midodrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

  • shepherd’s purse

    Monitor Closely (1)shepherd’s purse increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • solriamfetol

    Monitor Closely (1)midodrine and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • sufentanil

    Monitor Closely (1)sufentanil increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • sulfamethoxazole

    Minor (1)sulfamethoxazole will increase the level or effect of midodrine by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

  • tapentadol

    Monitor Closely (1)tapentadol increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • temazepam

    Monitor Closely (1)temazepam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • tenofovir DF

    Monitor Closely (1)tenofovir DF increases levels of midodrine by decreasing renal clearance. Use Caution/Monitor. Potential for increased toxicity. .

  • terbutaline

    Monitor Closely (2)terbutaline and midodrine both decrease sedation. Use Caution/Monitor.

    terbutaline and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • thioridazine

    Monitor Closely (2)thioridazine, midodrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

    thioridazine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • thiothixene

    Monitor Closely (1)thiothixene increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • topiramate

    Monitor Closely (1)topiramate increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

  • tramadol

    Monitor Closely (1)tramadol increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • tranylcypromine

    Contraindicated (1)tranylcypromine increases effects of midodrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

  • trazodone

    Monitor Closely (1)trazodone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious – Use Alternative (1)trazodone, midodrine. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

  • triamterene

    Minor (1)midodrine will increase the level or effect of triamterene by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

  • triazolam

    Monitor Closely (1)triazolam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • triclofos

    Monitor Closely (1)triclofos increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • trifluoperazine

    Monitor Closely (2)trifluoperazine, midodrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

    trifluoperazine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • trimethoprim

    Minor (1)midodrine will increase the level or effect of trimethoprim by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

  • trimipramine

    Monitor Closely (1)trimipramine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious – Use Alternative (1)trimipramine, midodrine. Other (see comment). Avoid or Use Alternate Drug.
    Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

  • triprolidine

    Monitor Closely (1)triprolidine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • verapamil

    Minor (1)midodrine will increase the level or effect of verapamil by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

  • xylometazoline

    Monitor Closely (2)midodrine and xylometazoline both decrease sedation. Use Caution/Monitor.

    midodrine and xylometazoline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • yohimbe

    Serious – Use Alternative (1)yohimbe, midodrine. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

  • yohimbine

    Monitor Closely (2)yohimbine and midodrine both decrease sedation. Use Caution/Monitor.

    midodrine and yohimbine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

  • ziconotide

    Monitor Closely (1)ziconotide increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • ziprasidone

    Monitor Closely (1)ziprasidone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • Midodrine (Oral Route) Proper Use

    Proper Use

    Drug information provided by: IBM Micromedex

    The last dose of midodrine should not be taken after the evening meal or less than 3 to 4 hours before bedtime because high blood pressure upon lying down (supine hypertension) can occur, which can cause blurred vision, headaches, and pounding in the ears while lying down after taking this medicine.

    Also, midodrine should not be taken if you will be lying down for any length of time.

    Dosing

    The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

    The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.


    • For oral dosage form (tablets):


      • For low blood pressure:


        • Adults—10 milligrams (mg) three times a day in approximately 4-hour intervals during daytime hours: shortly before or upon rising in the morning, at midday, and in the late afternoon (not later than 6 p.m.). Your doctor may increase your dose if needed.

        • Children—Use and dose must be determined by your doctor.

    Missed Dose

    If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

    Storage

    Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

    Keep out of the reach of children.

    Do not keep outdated medicine or medicine no longer needed.

    Ask your healthcare professional how you should dispose of any medicine you do not use.

     

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    .

    Midodrine – Uses, Side Effects, Interactions

    How does this medication work? What will it do for me?

    Midodrine belongs to the class of medications known as vasopressors. It is used to relieve symptoms of low blood pressure (such as dizziness, lightheadedness, and fainting) for people with Parkinson’s disease, diabetes, Bradbury-Eggleston syndrome, and Shy-Drager syndrome. It works by constricting the blood vessels, causing an increase in blood pressure.

    This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

    Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

    Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

    What form(s) does this medication come in?

    2.5 mg
    Each white, round tablet, scored and engraved “MID” over “2.5” on one side, contains 2.5 mg midodrine hydrochloride. Nonmedicinal ingredients: colloidal silicon dioxide, magnesium stearate, microcrystalline cellulose, and starch.

    5 mg
    Each orange, round tablet, scored and engraved “MID” over “5” on one side, contains 5 mg midodrine hydrochloride. Nonmedicinal ingredients: colloidal silicon dioxide, magnesium stearate, microcrystalline cellulose, starch, and FD&C Yellow No. 6 Aluminum Lake 40%.

    How should I use this medication?

    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 this medication 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 this medication 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.

    Who should NOT take this medication?

    Do not use this medication 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

    What side effects are possible with this medication?

    Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

    The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

    The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

    Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

    • burning, tingling, or prickling of the scalp or skin
    • chills
    • dizziness
    • erection of body hair
    • goose bumps
    • heartburn
    • increased or altered sensitivity to touch
    • irritability
    • itchy skin or scalp
    • nausea
    • stomach pain
    • weakness

    Although most of the side effects listed below don’t happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

    Check with your doctor as soon as possible if any of the following side effects occur:

    • abnormal heartbeat
    • abnormal loss of strength
    • headache
    • nervousness
    • pounding in the ears
    • skin rash
    • slow heartbeat
    • urinary problems (e.g., urinary frequency (urinating more often than usual), retention (difficulty passing urine), pain, or urgency (urgent need to urinate)
    • vision problems (e.g., blurred vision, wavy vision, dark spots, sudden loss of vision)

    Stop taking the medication and seek immediate medical attention if any of the following occur:

    • increased dizziness or faintness
    • loss of vision
    • persistently elevated supine (lying) blood pressure
    • shortness of breath
    • signs of an allergic reaction (shortness of breath or difficulty breathing; hives; swelling of the eyes, mouth, lips, or throat)

    Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

    Are there any other precautions or warnings for this medication?

    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 this medication.

    Abnormal heart rhythms: If you have abnormal heart rhythms, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, 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 this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, 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 this medication.

    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 this medication and close monitoring by your doctor may be needed.

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

    Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, 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 this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

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

    What other drugs could interact with this medication?

    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 (MAOIs; 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 this medication. 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.

    All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Midodrine

    Midodrine – an alpha-agonist – Bramox

    About midodrine

    Type of medicine An alpha-adrenergic sympathomimetic medicine (alpha-agonist)
    Used for Postural hypotension (low blood pressure when standing) due to autonomic nervous system dysfunction
    Also called Bramox®
    Available as Tablets

    Midodrine is used to treat the problem of having low blood pressure when standing up from a sitting position or when already standing. This condition is known as postural hypotension, or alternatively, orthostatic hypotension. A drop in your blood pressure when you stand up can make you feel dizzy and light-headed, or cause you to faint. This can also put you at risk of falling over. Other symptoms include blurred vision, weakness or tiredness (fatigue), feeling sick (nausea) a fast heartbeat (palpitations) and headaches.

    Postural hypotension can have a number of underlying causes. It may be caused by taking certain medicines or if you become lacking in fluid in the body (dehydrated) due to being sick (vomiting) or having diarrhoea. If this is the case, standing up slowly or sitting upright first before standing may help to manage your symptoms. Postural hypotension may also be caused by an underlying problem with your nervous system such as Parkinson’s disease or peripheral neuropathy.

    Midodrine is used when severe symptoms are being caused by a problem with your nervous system and other forms of treatment have not helped. It works by stimulating certain parts of your nervous system (alpha receptors) which has the effect of narrowing your blood vessels. As your blood vessels narrow, your blood pressure goes up. This helps stop any dizziness or fainting when you stand up.

    Before taking midodrine tablets

    Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking midodrine it is important that your doctor knows:

    • If you are pregnant, trying for a baby, or breastfeeding.
    • If you have high blood pressure (hypertension).
    • If you have been told you have a disorder of the nervous system.
    • If you have a heart condition or any problems with your blood vessels.
    • If you have any problems with your prostate gland or if you have difficulty passing urine.
    • If you have any problems with the way your kidneys or liver work.
    • If you have glaucoma, a condition which causes raised pressure in the eye(s).
    • If you have diabetes mellitus, a condition which raises your blood sugar levels. In particular, if your diabetes has caused any problems with your vision.
    • If you have an overactive thyroid gland (hyperthyroidism).
    • If you have a tumour on your adrenal gland, called phaeochromocytoma.
    • If you have ever had an allergic reaction to a medicine.
    • If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.

    How to take midodrine tablets

    • Before you start this treatment, read the manufacturer’s printed information leaflet from inside your pack. The manufacturer’s leaflet will give you more information about midodrine and a full list of side-effects which you may experience from taking it.
    • Take midodrine exactly as your doctor tells you to. Your dose will be written on the label of your pack to remind you.
    • The usual starting dose is one 2.5 mg tablet taken three times a day. Your blood pressure will need to be monitored and your dose may be increased each week until you find the lowest dose that controls your blood pressure. The maximum dose is 10 mg three times a day.
    • Swallow the tablets with a drink of water. It is not important whether you take your dose before or after food.
    • Do not take a dose of midodrine late in the evening, take your last dose of the day at least four hours before your bedtime.
    • If you forget to take a dose, take it as soon as you remember unless it is nearly time for your next dose or unless it is within four hours of your bedtime. In these cases leave out the forgotten dose and take your next dose when it is due. Do not take two doses together to make up for a forgotten dose.

    Getting the most from your treatment

    • Try to keep all your regular appointments with your doctor. This is so your doctor can check on your progress.
    • Your blood pressure may need to be monitored when you are lying down and when you are standing up. This is to make sure your blood pressure does not go too high when you are lying down. If your blood pressure does go up when you are lying down then your dose of midodrine may need to be reduced.
    • You may find it useful to have a blood pressure meter to use at home. Ask your doctor or pharmacist for advice about testing your blood pressure at home.
    • When you are lying down in bed try to keep your head raised – for instance, by using extra pillows. This is to help prevent your blood pressure going too high when you are lying down.
    • If you are having an operation or dental treatment, tell the person carrying out the treatment that you are taking midodrine.
    • If you buy any medicines, check with your doctor or a pharmacist that they are suitable for you to take with midodrine.

    Can midodrine tablets cause problems?

    Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with midodrine. You will find a full list in the manufacturer’s information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

    Vey common midodrine side-effects (these affect more than 1 in 10 people) What can I do if I experience this?
    Pain when passing urine Let your doctor know about this
    Goosebumps, itchy scalp If either of these become troublesome, let your doctor know
    Common midodrine side-effects (these affect less than 1 in 10 people) What can I do if I experience this?
    Feeling sick (nausea), indigestion or heartburn (reflux) Stick to simple meals – avoid rich or spicy foods
    Raised blood pressure when lying down Using a blood pressure meter at home may help to identify this. Let your doctor know if you have any concerns
    Headache Let your doctor know if you experience repeated headaches, especially if you also have blurred vision (see below)
    Difficulty passing urine Let your doctor know about this
    Chills, tingling or itchy skin, skin flushing, skin rash, swollen or painful lining of the mouth If any of these become troublesome let your doctor know

    Important: taking midodrine may cause your blood pressure to go too high. This can be a particular problem if it happens when you are lying down. Your dose may need to be reduced or your treatment stopped. Your doctor will monitor your blood pressure and it may also help to use a blood pressure meter at home.

    Let your doctor know if you think your blood pressure is too high or if you experience symptoms such as:

    • Chest pain
    • A fast heartbeat (palpitations)
    • Shortness of breath
    • Headaches
    • Blurred vision

    If you experience any other symptoms which you think may be due to this medicine, speak with your doctor or pharmacist.

    How to store midodrine tablets

    • Keep all medicines out of the reach and sight of children.
    • Store in a cool, dry place, away from direct heat and light.
    • Midodrine tablets that are packaged in a bottle must be used within eight weeks of opening the bottle.

    Important information about all medicines

    Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.

    This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

    Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

    If you have any questions about this medicine ask your pharmacist.

    Midodrine 5mg Inramed | Exporter | Supplier

    Description

    Midodrine 5mg Tablet Inramed is utilized to treat low circulatory strain (hypotension). It is utilized in patients who experience wooziness because of a low pulse while standing up unexpectedly from a sitting or lying position. This medication causes the fixing of veins and results in raising your circulatory strain.

    How Midodrine 5mg Tablet Inramed can be used?

    Midodrine 5mg Tablet Inramed can be taken with or without food. This medication is taken during daytime hours when individuals stand frequently. However, it ought not to be taken if you will rest for quite a while after the portion. You ought to consistently accept this medication as exhorted by the specialist and ought to never stop it without speaking with the specialist. You should screen your pulse routinely while taking this medication.

    Side effects of Midodrine 5mg Tablet Inramed:

    Regular results of this medication incorporate cerebral pain, sickness, rash, and trouble in pee. Counsel to your primary care physician if these results trouble you. It might likewise cause prostrate hypertension, it is an expansion in your circulatory strain while resting.

    Before taking this Tablet, it is smarter to inform your PCP as to whether you are experiencing any kidney or liver infection. Likewise, pregnant ladies and breastfeeding moms ought to counsel specialists before taking it. You should educate specialists pretty much the wide range of various prescriptions that you are dismantling from this medication. Your primary care physician may request observing kidney and liver capacity previously and during the treatment with this medication. For more details click here.

    Trademark:- Inramed

    Maker: Mylan Pharmaceuticals

    Show: Tablet

    Strength:  5mg

    We are exporting medicines from India to different countries like United Arab Emirates, United States, Brazil, Saudi Arabia, etc. If you are looking for another product or brand click here.

    Midodrine (Midodrine): description, recipe, instruction

    Midodrine

    Analogues (generics, synonyms)

    Active ingredient

    Midodrinum

    Pharmacological group

    Alpha-adrenergic agonists, Hypertensive drugs

    Recipe

    International:

    Rp. “Midodrine” 2.5 mg
    D.t.d. No. 20 in tabl.
    S. 1 tablet 2 times a day

    Russia:

    Prescription form 107-1 / y

    Pharmacological action

    vasoconstrictor, hypertensive.Forms an active metabolite, which is an agonist of alpha1-adrenergic receptors and interacts with them in arterioles and venules. Increases vascular tone and blood pressure. It does not have a stimulating effect on the alpha-adrenergic receptors of the heart, heart rate, myocardial contractility, does not affect the tone of the smooth muscles of the bronchi. Does not penetrate the BBB and does not affect the central nervous system. When used in a dose of 10 mg in patients with orthostatic hypotension, it increases blood pressure by 15–30 mm Hg. 1 hour after administration; the effect can last for 2-3 hours.

    Quickly absorbed after oral administration. Absolute bioavailability – 93%, does not depend on food intake. In the blood only partially binds to proteins. Cmax in plasma is reached after 1-2 hours, T1 / 2 is 3-4 hours. The main pathway of biotransformation is deglycination. Desglimidodrine (the main metabolite) is produced in many tissues. Final degradation occurs in the liver. It is excreted in the urine (by renal secretion) almost completely within 24 hours: in the form of an active metabolite (40%), an unchanged drug (5%) and inactive metabolites (55%).

    Pharmacodynamics

    There is no data for this section. We are currently processing information, please come back later.

    Pharmacokinetics

    There is no data for this section. We are currently processing information, please come back later.

    Method of application

    For adults:

    Inside 2.5 mg 2 times a day (1 tablet or 7 drops of a 1% solution 2 times a day), if necessary, increase with an interval of 1 week to 5 mg 2 times a day.If long-term treatment is necessary, the dose can be reduced to 1.25 mg 1-2 times a day (3 drops of a 1% solution once a day).

    Intravenous 5 mg 2 times a day. No more than 30 mg per day.

    Readings

    Orthostatic hypotension (with reactions of the type of sympathicotonia and asympathicotonia), idiopathic orthostatic hypotension, secondary orthostatic hypotension, arterial hypotension (against the background of psychoactive drugs, during convalescence after surgery and childbirth), secondary hypotension in infectious diseases, arterial hypotension with changes in the weather urine (involuntary urination with dysfunction of the bladder sphincter).

    Contraindications

    Arterial hypertension.

    Pheochromocytoma.

    Obliterating arterial disease.

    Spasm of peripheral arteries.

    Angle-closure glaucoma.

    Prostatic hyperplasia with urinary retention.

    Mechanical obstruction of the urinary tract.

    Individual intolerance.

    Thyrotoxicosis.

    Special instructions

    There is no data for this section.We are currently processing information, please come back later.

    Side effects

    Clinostatic hypertension is a sharp rise in blood pressure when moving to the supine position.

    Systemic action: more often – tachycardia or bradycardia, headache, tremor, anxiety; less often, dizziness, insomnia, sweating, nausea and / or vomiting; rarely – arrhythmias, hypertension or hypotension, anginal pain, hypokalemia, muscle spasms or twitching, oliguria, sleep disturbances, neuropsychiatric disorders (psychomotor agitation, memory impairments, hallucinations, suicidal attempts and other disorders), paradoxical or caused by a hypersensitivity reaction, bronchospasm, allergic reactions , lactic acidosis.

    Heartburn, dry mouth, nausea, dyspeptic disorders, flatulence, aphthous stomatitis.

    Increased sweating, pilomotor reaction (“goose bumps”), pruritus, chills, soreness of the skin.

    Narrowing of visual fields.

    Overdose

    There is no data for this section. We are currently processing information, please come back later.

    Drug interactions

    There is no data for this section. We are currently processing information, please come back later.

    Form of issue

    Tablets containing 0.0025 g (2.5 mg) of midodrine, in a package of 20 or 50 pieces; 1% solution in vials of 10; 20 or 25 ml; 0.25% solution in 2 ml ampoules (5 mg in an ampoule) in a package of 5 ampoules.

    Midodrin (gutron)

    In terms of chemical structure and pharmacological properties, midodrin is close to adrenaline-like sympathomimetic substances. It has a vasoconstrictor and pressor (increasing blood pressure) effect.Like norepinephrine and mesatone, it stimulates mainly alpha-adrenergic receptors, having little effect on beta-adrenergic receptors; does not have a significant effect on heart rate, myocardial contractility (heart muscle), as well as on the muscles of the brochnas. The vasoconstrictor effect develops more slowly and more evenly than with the use of norepinephrine, mezaton.

    Midodrine is used for various types of hypotension (low blood pressure): with orthostatic hypotension (a drop in blood pressure during the transition from a horizontal to a vertical position), caused by a violation of the tone of the sympathetic nervous system, with idiopathic (of unknown origin) orthostatic hypotension, secondary hypotension, associated with infectious diseases, injuries, the use of drugs.

    Midodrin is administered orally and intravenously.
    Inside appoint usually 1 tablet containing 2.5 mg 2 (less often 3) times a day or 7 drops of 1% solution 2 times a day. When a clinical effect is achieved and for long-term therapy, 1/2 tablet (1.25 mg) is prescribed 2 times a day or 3 drops of a% solution 2 times a day. In some cases, first appoint 2 tablets (5 mg) 2 times a day. The contents of 1 ampoule (5 mg) are administered intravenously, if necessary, 2 times a day.

    Treatment with midodrine should be carried out under the control of blood pressure and other hemodynamic parameters.If the dose is exceeded or individual hypersensitivity is possible, a hypertensive reaction (an increase in blood pressure above normal), bradycardia (rare pulse), increased sweating, a pilomotor reaction (“goose bumps”), disturbances (delay or increased frequency) of urination are possible.

    The drug is contraindicated in hypertension (high blood pressure), pheochromocytoma (adrenal tumors), spastic and obliterating peripheral vascular diseases (vascular diseases with narrowing of their lumen due to spasm or atherosclerotic deposits), thyrotoxicosis (thyroid tumor) ) prostate gland, angle-closure glaucoma (increased intraocular pressure).Caution should be exercised when treating patients with heart failure and arrhythmia, impaired renal function.
    You should not prescribe midodrine during pregnancy.

    Tablets containing 0.0025 g (2.5 mg) of midodrine, in a package of 20 or 50 pieces; 1% solution in vials of 10; 20 or 25 ml; 0.25% solution in 2 ml ampoules (5 mg in an ampoule) in a package of 5 ampoules.

    List B. In the dark place.

    Gutron, Alfamin, Hypertan, Midamin.

    Clinical study Hypotension after spinal anesthesia: Midodrine Oral Product, Inert sugar tablet (placebo) – Clinical trial registry

    Detailed description

    Neuraxial block, such as spinal anesthesia, can cause severe hypotension due to: pharmacological sympathectomy, with potentially fatal consequences for the patient. Prevention of hypotension caused by spinal anesthesia is of utmost importance.Several techniques and methodologies have been adopted to prevent this neuraxial hypotension, with varying degrees of success. Currently used methods of preventing hypotension include intravenous fluid prehydration, sympathomimetic drugs, and physical methods such as leg wraps and compression stockings. Direct-acting midodrine is an α1-adrenergic receptor agonist, which causes narrowing of venous and arterial vessels by stimulating α1-receptors located in the vasculature.The end result is an increase in vascular tone. and systolic blood pressure. Cardiac β-receptors are unaffected and there is no significant penetration across the blood-brain barrier. We assume that intraoperative hypotension will be less. in patients who received midodrine and pre-hydration of fluid intravenously before surgery before spinal anesthesia. The study will include 80 patients who will be prescribed planned orthopedic treatment. operations on the lower extremities under spinal anesthesia.It will be held at Mansour University Hospital after receiving approval from the Institutional Review Board (IRB), Mansour University School of Medicine. Informed written consent will be obtained from all research subjects after ensuring confidentiality. Patients will be randomly assigned using computer-generated random numbers for either midodrin treatment (group M) or control (group C) using the sealed opaque envelope technique.Group M patients will receive a 10 mg oral midodrine tablet with small sips of water one hour before arriving in the operating room, while Group C patients will receive an inert sugar tablet (placebo) at the same time. All patients will be under non-invasive blood pressure monitoring. as well as continuous electrocardiogram (ECG) and pulse oximetry (SpO2). Prior to placement of spinal anesthesia, all patients will receive a bolus of 10 ml / kg Ringer’s lactate.Spinal anesthesia (median puncture) will be performed in a seated position by the staff. anesthetist in L3-L4 or L4-L5 with a 25-gauge Withacre needle injecting 12.5 mg hyperbaric 0.5% bupivacaine (2.5 ml) with 10 mcg fentanyl. After the injection, patients will be drawn to supine. Baseline arterial blood pressure (mean) will be calculated as the mean of 3 consecutive measurements before CA insertion every 15 minutes after taking midodrine and every 5 minutes for 30 minutes after spinal anesthesia.Any vasovagal syncope is recorded. Once the SA is installed, the patient’s heart rate will be measured every five minutes for 30 minutes, and then, in accordance with standard clinical practice, every 5 minutes until the end of the operation. At the dermatome level, the pinhole sensory block will be checked every 5 minutes for 20 minutes. The modified Bromage scale (0 = no motor block, 1 = straight hip flexion, 2 = blocked knee flexion, 3 = full motor block) will be used to quantify the degree of motor block after 20 minutes.Requirements Consumption of ephedrine, atropine and liquid will be recorded. the time to the onset of the first hypotension, the proportion of patients without hypotension and the number of bradycardic episodes will also be recorded per patient. Perioperative complications such as reactive hypertension, nausea, vomiting, hypothermia, tremors, and postdural headache. sign up. A researcher who does not know the type of intervention will be responsible for collecting the data.

    Instruction Midodrin

    Name: Midodrin

    In terms of chemical structure and pharmacological properties, midodrin is close to adrenaline-like sympathomimetic substances.It has a vasoconstrictor and pressor (increasing blood pressure) effect. Like norepinephrine and mesatone, it stimulates mainly alpha-adrenergic receptors, having little effect on beta-adrenergic receptors; does not significantly affect the heart rate, myocardial contractility (heart muscle), as well as the muscles of the bronchi.
    The vasoconstrictor effect develops more slowly and more evenly than with the use of norepinephrine and mezaton.

    Midodrine is used for various types of hypotension (low blood pressure): with orthostatic hypotension (a drop in blood pressure during the transition from horizontal to vertical position), caused by a violation of the tone of the sympathetic nervous system, with idiopathic (of unknown origin) orthostatic hypotension, secondary hypotension, associated with infectious diseases, injuries, the use of drugs.

    Midodrin is administered orally and intravenously.
    Inside appoint usually 1 tablet containing 2.5 mg 2 (less often 3) times a day or 7 drops of 1% solution 2 times a day. When the clinical effect is achieved and for long-term therapy, 1/2 tablet (1.25 mg) is prescribed 2 times a day or 3 drops of a 1% solution 2 times a day. In some cases, first appoint 2 tablets (5 mg) 2 times a day.
    The contents of one ampoule (5 mg) are administered intravenously, if necessary, 2 times a day.

    Treatment with midodrine should be carried out under the control of blood pressure and other hemodynamic parameters. If the dose is exceeded or individual hypersensitivity is possible, a hypertensive reaction (an increase in blood pressure above normal), bradycardia (rare pulse), increased sweating, a pilomotor reaction (“goose bumps”), disturbances (delay or increased frequency) of urination are possible.

    The drug is contraindicated in hypertension (high blood pressure), pheochromocytoma (adrenal tumors), spastic and obliterating peripheral vascular diseases (vascular diseases with narrowing of their lumen due to spasm or atherosclerotic deposits), thyrotoxicosis (thyroid tumor) ) prostate gland, angle-closure glaucoma (increased intraocular pressure).Caution should be exercised when treating patients with heart failure and arrhythmia, impaired renal function.
    You should not prescribe midodrine during pregnancy.

    Tablets containing 0.0025 g (2.5 mg) of midodrine in a package of 20 or 50 pieces; 1% solution in vials of 10; 20 or 25 ml; 0.25% solution in 2 ml ampoules (5 mg in an ampoule) in a package of 5 ampoules.

    List B. In the dark place.

    Gutron, Alfamin, Hypertan, Midamin, etc.

    Mezaton is also part of Coldrex, Rhinopront, Phenylephrine + Tramazoline, Teva Coldex, Coldex Powders.

    Before using the drug Midodrin you should consult your doctor. These instructions for use are given in free translation and are intended solely for information. For more information, please refer to the manufacturer’s annotation.

    Drug price:
    The price of the drug can be clarified by using the search on the website or by calling the free medical information service “MedDovidka” – (044) 581-6000, or 1577.

    instructions for use, analogs, composition, indications

    Be sure to inform your attending physician about all medications that you take together with Biosotal, even if it happens from time to time.

    Many medicines can cause bradycardia. These include class Ia antiarrhythmics, beta-blockers, some class III antiarrhythmics, some calcium antagonists, digoxin, pilocarpine, anticholinesterase drugs, etc.
    Many antiarrhythmic drugs suppress the automatism, conduction and contractility of the heart. The combination of antiarrhythmic drugs of various classes can have a beneficial therapeutic effect, but most often it turns out to be very complex, requiring clinical observation and ECG monitoring. The combination of antiarrhythmic drugs that cause arrhythmias of the “pirouette” type (amiodarone, disopyramide, quinidinines, sotalol …) is contraindicated.
    The combination of antiarrhythmic drugs of the same class is not recommended due to the increased risk of undesirable effects on the heart and is possible only in exceptional cases.
    The combination with drugs with negative inotropic properties, causing bradycardia and / or slowing down atrioventricular conduction, is complex and requires clinical observation and ECG monitoring.
    Pirouette arrhythmias, a serious irregular heartbeat, can be caused by certain drugs, antiarrhythmics, or others. Hypokalemia is a contributing factor to the development of arrhythmias, as is bradycardia or preexisting lengthening of the QT interval, congenital or acquired.
    Medicines causing this undesirable effect are antiarrhythmics of classes Ia and III and some antipsychotics. Other molecules not belonging to these classes can have this effect.
    The combined use of one drug with a proarrhythmic effect (causing arrhythmias of the “pirouette” type) with another drug with a proarrhythmic effect is contraindicated.
    Some drugs, such as methadone, hydroxychloroquine, antiparasitic agents (chloroquine, halofantrine, lumefantrine, pentamidine) and antipsychotics, are not recommended for concomitant use with other drugs that can cause pirouette-type tachycardia, unless this combination cannot be avoided …

    Contraindicated combinations:
    + Medicines that can cause pirouette-type tachycardia: amiodarone, lec. drugs containing arsenic, citalopram, diphemanil, disopyramide, intravenous dolasetron, domperidone, dronedarone, intravenous erythromycin, escitalopram, hydroquinidine, hydroxyzine, mequitazine, mizolastine, moxifloxacin, intravenous piperaquin antiparasitic drugs, antipsychotics, methadone, hydroxychloroquine)
    Higher risk of ventricular arrhythmias, especially pirouette tachycardia.

    Combinations not recommended:
    + Fingolimod
    Potentiation of the risks of bradycardia, with possible fatal consequences. Beta blockers interfere with adrenergic compensatory mechanisms. Clinical observation and continuous ECG monitoring are necessary within 24 hours after the first dose.

    + Antipsychotics capable of causing pirouette-type arrhythmias (amisulpride, chlorpromazine, cyamemazine, droperidol, flupenthixol, fluphenazine, haloperidol, levomepromazine, pimozide, pipamperone, 90pipothiopridiazine, sultoprileprid194)
    Increased risk of ventricular arrhythmias, especially pirouette tachycardia.

    + Calcium channel antagonists (diltiazem and verapamil)
    Disorders of automatism (excessive bradycardia, stopping of the sinus node), disorders of sinoauricular and atrioventricular conduction, and heart failure.
    This combination can only take place with close clinical observation and ECG monitoring, especially in elderly patients or at the beginning of treatment.

    + Antiparasitic agents capable of causing pirouette-type arrhythmias (chloroquine, halofantrine, lumefantrine, pentamidine)
    Increased risk of ventricular arrhythmias, especially pirouette tachycardia.
    Stop taking one of the two drugs if possible. If a combination cannot be avoided, preliminary QT control and ECG monitoring are necessary.

    + Hydroxychloroquine
    Increased risk of ventricular arrhythmias, especially pirouette tachycardia.

    + Methadone
    Increased risk of ventricular arrhythmias, especially pirouette tachycardia.

    Combinations requiring caution in use:
    + Halogenated volatile anesthetics (desflurane, enflurane, halothane, isoflurane, methoxyflurane, sevoflurane)
    Decrease in compensatory cardiovascular reactions with beta-blockers.During the intervention, beta-adrenergic inhibition can be reduced by beta-mimetics.
    As a rule, taking sotalol does not stop. Avoid abrupt withdrawal of the drug if necessary and inform the anesthesiologist about this treatment.

    + Azithromycin
    Increased risk of ventricular arrhythmias, especially pirouette tachycardia.
    Clinical observation and electrocardiographic monitoring during joint use.

    + Propafenone
    Violations of contractility, automatism and conduction (suppression of compensatory sympathetic mechanisms).
    Clinical observation and ECG monitoring.

    + Other drugs that induce bradycardia (acebutolol, ambenonium, atenolol, befunolol, betaxolol, carteolol, carvedilol, celiprolol, clonidine, crizotinib, digoxin, donepezil, esmolol, fampridinesva, galradinolamide, laeflobodin, levloblobodine, methradine, levlobodine , nadolol, nadoxolol, neostigmine, oxprenolol, pazireotide, pilocarpine, pindolol, propanolol, pyridostigmine, rivastigmine, tertatolol, thalidomide, timolol)
    Increased risk of ventricular arrhythmias, especially pirouette tachycardia.
    Clinical observation and electrocardiographic monitoring.

    + Central antihypertensive (blood pressure lowering) drugs (clonidine, methyldopa, Moxonidine, rilmenidine)
    A significant increase in blood pressure in the event of a sharp cessation of treatment with antihypertensive drugs of central action.
    Avoid abrupt withdrawal of treatment with a central antihypertensive agent. Clinical observation.

    + Drugs causing hypokalemia (altizid, amphotericin B intravenously, bendroflumethiazide, betamethasone, bisacodyl, boldo, buckthorn brittle, bumetinide, buckthorn, American buckthorn, chlorthalidone, cycletαnine, clopamidazidazol, cortislothurone, cortemazone hydrochlorothiazide, hydrocortisone, indapamide, methiclothiazide, methylprednisolone, pyretanide, prednisolone, prednisone, licorice, rhubarb, castor bean, senna, Khartoum senna, Indian senna, sodium docusate, sodium picosulfate, sodium ricinoleate, tricinoleate 18, tetrakipolacin4)
    Increased risk of ventricular arrhythmias, especially pirouette tachycardia.
    It is necessary to correct hypokalemia before taking the drug and monitor electrolyte levels, clinical and electrocardiographic monitoring.

    + Insulin, sulfonylurea derivatives (carbutamide, chlorpropamide, glibenclamide, glibomuride, gliclazide, glimepiride, glipizide, tolbutamide), glinides (nateglinide, repaglinide), gliptins (linagliptin19, sitagliptin) 904
    All beta blockers can mask some of the symptoms of hypoglycemia: palpitations and tachycardia.
    Warn patient and advise to increase self-control of glycemia, especially at the beginning of treatment.

    + Lidocaine (intravenous)
    Increase in plasma concentrations of lidocaine with the possibility of cardiological and neurological adverse events (decrease in hepatic clearance of lidocaine).
    Clinical observation, ECG and, if necessary, monitoring the concentration of lidocaine in plasma during the combination and after discontinuation of the beta-blocker.
    If necessary, adaptation of the dose of lidocaine.

    + Ondansetron
    Increased risk of ventricular arrhythmias, especially pirouette tachycardia.
    Clinical and electrocardiographic observation during combined use.

    + Fluoroquinolones (ciprofloxacin, levofloxacin, norfloxacin)
    Increased risk of ventricular arrhythmias, especially pirouette tachycardia.Clinical and electrocardiographic observation during combination.

    + Anagrelide
    Increased risk of ventricular arrhythmias, especially pirouette tachycardia.
    Clinical and electrocardiographic observation during combination.

    + Clarithromycin
    Increased risk of ventricular arrhythmias, especially pirouette tachycardia.
    Clinical and electrocardiographic observation during combination.

    + Roxithromycin
    Increased risk of ventricular arrhythmias, especially pirouette tachycardia.
    Clinical and electrocardiographic observation during combination.

    + Beta-blockers for heart failure (bisoprolol, carvedilol, metoprolol, nebivolol)
    Increased risk of ventricular arrhythmias, especially pirouette tachycardia.
    Clinical and electrocardiographic observation.

    Combinations to be taken into account:
    + Nonsteroidal anti-inflammatory drugs (aceclofenac, mefenamic acid, niflumic acid, tiaprofenic acid, alminoprofen, celecoxib, dexcametholamide, dicaprofen ibuprofen, indomethacin, ketoprofen, meloxicam, morniflumate, nabumetone, naproxen, nimesulide, parecoxib, phenylbutazone, piroxicam, piroxicam-betadex, rofecoxib, sulindac, tenoxicam, valdecoxib)
    900
    Reducing the hypotensive effect (inhibition of vasodilating prostaglandins by non-steroidal anti-inflammatory drugs, fluid retention by phenylbutazone).

    + Dihydropyridines (amlodipine, barnidipine, clevidipine, felodipine, isradipine, lacidipine, lercanidipine, manidipine, nicardipine, nifedipine, nimodipine, nitrendipine)
    Hypotension, worsening of heart failure in patients with latent or uncontrolled heart failure (adding a negative inotropic effect). Along with this, a beta blocker can minimize the reflex sympathetic response associated with an excessive hemodynamic response.

    + Nitrates and related derivatives (isosorbide dinitrate, isosorbide, linsidomin, molsidomin, nicorandil, trinitrin)
    Increased risk of hypotension, including orthostatic.

    + Dipyridamole (intravenous)
    Strengthening the hypotensive effect.

    + Alpha-blockers used in urology (alfuzosin, doxazosin, prazosin, silodosin, tamsulosin, terazosin)
    Strengthening the hypotensive effect.Increased risk of orthostatic hypotension.

    + Antihypertensive alpha-blockers (urapidil)
    Strengthening the hypotensive effect. Increased risk of orthostatic hypotension.

    + Medicines causing orthostatic hypotension (acepromazine, aceprometazine, alfuzosin, alimemazine, alizapride, amantadine, amifostine, amitriptyline, amoxapine, apomorphine, aripiprazole, asenapine, avanaphil, baclaprophin isosorbide dinitrate, dozulepine, doxepin, droperidol, entacapone, pluanisone, imipramine, levodopa, lisuride, loxapine, maprotiline, metopimazine, molsidomine, nortriptyline, olanzapine, opipramol, oxomemidazine, palyphenazine , prochlorperazine, promethazine, propericiazine, rasagiline, riocigat, risperidone, ropinirole, selegiline, sildenafil, tadalafil, thioproperazine, tolcapone, trifluoperazine, trifluperidol, trimipramine, vardenafil) 9019
    Increased risk of hypotension, including orthostatic.