Midodrine

Midodrine

Drug monograph · NCLEX study reference
Trade names	ProAmatine
Therapeutic class	Vasopressor for hypotension
Pharmacologic class	Alpha-1 adrenergic agonist
Onset / peak / duration	Onset within 1 hour; duration 2 to 3 hours.
Half-life / level	Active metabolite half-life about 3 to 4 hours; no routine level.
Routes	PO (oral)
High-alert (ISMP)	No
Black box warning	Yes (see Safety)
Antidote / reversal	Supportive care; treat supine hypertension.
Pregnancy / lactation	Use only if clearly needed.

Nursing pharmacology study reference (NCLEX-style monograph). Numeric values are standard teaching ranges for study and must be verified against current manufacturer labeling before clinical use. This is educational content, not prescribing guidance.

Midodrine (brand name ProAmatine) — Vasopressor for hypotension; Alpha-1 adrenergic agonist.

Identification

• Therapeutic class: Vasopressor for hypotension.
• Pharmacologic class: Alpha-1 adrenergic agonist.

Pharmacology

• Mechanism of action: Stimulates peripheral alpha-1 receptors to increase vascular tone and raise blood pressure.
• Onset / peak / duration: Onset within 1 hour; duration 2 to 3 hours.
• Half-life / therapeutic level: Active metabolite half-life about 3 to 4 hours; no routine level.

Clinical use

• Indications: Symptomatic orthostatic hypotension.
• Usual dose, route, frequency: 10 mg PO three times daily during waking hours.
• Maximum dose / adjustments: Reduce in renal impairment; do not dose within 4 hours of lying down.

Safety

• Contraindications: Severe organic heart disease, acute kidney injury, urinary retention, thyrotoxicosis, supine hypertension.
• Black box warning: Can cause marked supine (lying down) hypertension; reserve for patients significantly impaired despite other measures.
• Interactions: Other vasopressors, beta blockers (bradycardia), drugs that raise blood pressure.
• Pregnancy / lactation: Use only if clearly needed.
• High-alert: No.

Adverse effects

• Common side effects: Scalp tingling, goosebumps, urinary urgency, supine hypertension.
• Serious effects to report: Severe supine hypertension, urinary retention, bradycardia.
• Antidote / reversal: Supportive care; treat supine hypertension.

Nursing process

• Assessment before administration: Supine and standing blood pressure, renal function.
• Interventions during therapy: Give doses during the day; keep head of bed elevated; last dose at least 4 hours before bedtime.
• Monitor: Supine and standing blood pressure, renal function.
• Evaluation / expected outcome: Reduced orthostatic symptoms.

Patient teaching

• Patient teaching: Do not take right before lying down; report pounding headache when lying flat.
• Notify provider if: Pounding headache or blurred vision when lying down, difficulty urinating.
• Administration tips: Daytime dosing only; avoid the last dose near bedtime.