Midodrine Medical Valley: Uses, Dosage & Side Effects
An alpha-1 adrenergic agonist used to treat symptomatic orthostatic hypotension (low blood pressure upon standing) when other measures have been insufficient
Midodrine Medical Valley contains midodrine hydrochloride, a selective alpha-1 adrenergic agonist used for the treatment of symptomatic orthostatic hypotension – a condition in which blood pressure drops significantly upon standing, causing dizziness, lightheadedness, and sometimes fainting. Midodrine is a prodrug that is converted in the body to its active metabolite desglymidodrine, which constricts blood vessels and raises blood pressure. It is prescribed when non-pharmacological measures such as increased fluid and salt intake, compression garments, and physical countermaneuvers have not adequately controlled symptoms. Midodrine Medical Valley is available as 2.5 mg tablets and requires a prescription.
Quick Facts: Midodrine Medical Valley
Key Takeaways
- Midodrine Medical Valley contains midodrine hydrochloride 2.5 mg, an alpha-1 adrenergic agonist that raises blood pressure by constricting blood vessels, making it effective for treating symptomatic orthostatic hypotension.
- The blood pressure-raising effect begins within 30–60 minutes and lasts approximately 3–4 hours, which is why it is typically taken two to three times daily during daytime waking hours only.
- The most important safety concern is supine hypertension (dangerously high blood pressure when lying down); patients must avoid lying flat for 3–4 hours after taking a dose and should not take midodrine within 4 hours of bedtime.
- Common side effects include piloerection (goosebumps), scalp tingling or itching, and urinary urgency – these are pharmacologically predictable effects of alpha-1 stimulation and are usually manageable with dose adjustment.
- Midodrine is contraindicated in patients with severe organic heart disease, pheochromocytoma, acute renal disease, urinary retention, or uncontrolled hypertension, and should be used with caution alongside beta-blockers or cardiac glycosides.
What Is Midodrine Medical Valley and What Is It Used For?
Midodrine Medical Valley contains the active substance midodrine hydrochloride, which belongs to a class of medications known as alpha-1 adrenergic agonists (also called sympathomimetic agents). These medications mimic the action of the sympathetic nervous system – the part of the autonomic nervous system responsible for the “fight or flight” response – specifically at alpha-1 receptors found on the smooth muscle walls of blood vessels. By stimulating these receptors, midodrine causes blood vessels to constrict (narrow), which increases peripheral vascular resistance and raises blood pressure.
Midodrine itself is a prodrug, meaning it is not pharmacologically active in its parent form. After oral administration, midodrine is rapidly absorbed from the gastrointestinal tract and undergoes enzymatic hydrolysis (cleavage) to form its active metabolite, desglymidodrine (also known as DMAE, or 1-(2′,5′-dimethoxyphenyl)-2-aminoethanol). Desglymidodrine is the compound responsible for the therapeutic blood pressure-raising effect. This prodrug approach allows for better oral bioavailability compared to administering the active metabolite directly.
The primary indication for Midodrine Medical Valley is the treatment of symptomatic orthostatic hypotension (also called postural hypotension). Orthostatic hypotension is defined as a sustained reduction in systolic blood pressure of at least 20 mmHg or diastolic blood pressure of at least 10 mmHg within 3 minutes of standing up from a supine position. While brief drops in blood pressure upon standing are normal and rapidly corrected by the body’s baroreceptor reflex, patients with orthostatic hypotension experience a prolonged or exaggerated drop that leads to symptoms including dizziness, lightheadedness, blurred vision, weakness, fatigue, cognitive impairment, neck and shoulder pain (known as “coat-hanger pain”), and syncope (fainting).
Orthostatic hypotension is particularly common among elderly individuals, affecting an estimated 15–20% of adults over age 65. It can result from a variety of underlying causes, including autonomic nervous system disorders (such as pure autonomic failure, multiple system atrophy, and diabetic autonomic neuropathy), medication side effects (particularly from antihypertensives, diuretics, tricyclic antidepressants, and alpha-blockers), prolonged bed rest, dehydration, and idiopathic causes. The consequences of orthostatic hypotension extend beyond the immediate symptoms: recurrent falls are a significant concern, particularly in older adults, and can lead to fractures, head injuries, and loss of independence.
Midodrine is typically reserved for patients whose orthostatic hypotension symptoms significantly impair daily functioning and who have not responded adequately to non-pharmacological interventions. These interventions include increasing fluid intake (2–3 liters per day), liberal salt consumption, wearing compression stockings or abdominal binders, physical countermaneuvers (such as leg crossing and squatting), sleeping with the head of the bed elevated, and avoiding rapid postural changes. The European Society of Cardiology (ESC) 2018 Guidelines on Syncope and the American Heart Association (AHA) guidelines both recommend these lifestyle modifications as first-line therapy, with pharmacological treatment added when they are insufficient.
After you take a Midodrine Medical Valley tablet, it is absorbed and converted to its active form (desglymidodrine) within about 30 minutes. Desglymidodrine then activates alpha-1 receptors on the smooth muscle of arteries and veins, causing them to constrict. This narrowing of blood vessels increases the resistance against which the heart pumps, raising both systolic and diastolic blood pressure. The effect is most pronounced on standing blood pressure, helping to prevent the dangerous drop that occurs when you get up from a seated or lying position.
What Should You Know Before Taking Midodrine Medical Valley?
Contraindications
Midodrine Medical Valley must not be used in certain conditions where raising blood pressure or stimulating alpha-1 receptors could be harmful or dangerous. Understanding these absolute contraindications is essential before starting treatment.
- Hypersensitivity: Do not take midodrine if you are allergic to midodrine hydrochloride or any of the other ingredients in the tablets.
- Severe organic heart disease: Midodrine is contraindicated in patients with severe forms of heart disease, including severe coronary artery disease, heart failure, acute myocardial infarction, or conditions where increasing peripheral vascular resistance could worsen cardiac function.
- Hypertension: Midodrine must not be used in patients with uncontrolled hypertension, as it would further elevate already dangerously high blood pressure.
- Pheochromocytoma: This rare adrenal gland tumor produces excess catecholamines. Adding midodrine could trigger a hypertensive crisis.
- Acute renal disease: Severe kidney impairment can lead to accumulation of midodrine and its active metabolite, increasing the risk of toxicity.
- Urinary retention: Midodrine stimulates alpha-1 receptors in the urinary tract, which can worsen urinary retention. It should not be used in patients with mechanical urinary obstruction or those with significant difficulty urinating.
- Thyrotoxicosis: Hyperthyroid states increase cardiovascular sensitivity to sympathomimetic agents, creating an unacceptable risk of arrhythmias and hypertensive episodes.
- Closed-angle glaucoma: Alpha-1 stimulation can cause pupil dilation (mydriasis), which may precipitate an acute attack of closed-angle glaucoma in susceptible individuals.
- Prostatic hyperplasia: In men with significant benign prostatic hyperplasia (BPH), midodrine may worsen urinary obstruction through contraction of the smooth muscle in the prostatic urethra and bladder neck.
Warnings and Precautions
The most significant and common adverse effect of midodrine is supine hypertension (elevated blood pressure when lying down). Because midodrine raises blood pressure systemically, lying flat allows gravity to redistribute blood centrally, amplifying the pressor effect. Patients should not lie completely flat for at least 3–4 hours after taking a dose. The head of the bed should be elevated to at least 30 degrees if lying down is necessary. Blood pressure should be measured both standing and supine, and if supine systolic blood pressure exceeds 180 mmHg, the dose should be reduced or the medication discontinued.
Before and during treatment with Midodrine Medical Valley, inform your doctor if any of the following apply:
- Kidney impairment: Since the active metabolite desglymidodrine is primarily eliminated by the kidneys, patients with reduced kidney function may accumulate higher levels of the drug. Dose reduction and careful monitoring are required. Midodrine is contraindicated in acute renal disease but may be used cautiously in mild-to-moderate chronic kidney disease.
- Liver impairment: Midodrine is metabolized (converted to desglymidodrine) partly in the liver. Patients with hepatic impairment may have altered drug metabolism. Dose adjustment and monitoring may be needed.
- Diabetes mellitus: Patients with diabetic autonomic neuropathy frequently have orthostatic hypotension. However, midodrine should be used with particular care in diabetic patients, as blood pressure regulation may be more labile and the risk of supine hypertension may be increased.
- Cardiovascular disease: Use with caution in patients with atherosclerosis, Raynaud’s phenomenon, or other conditions affecting peripheral circulation. The vasoconstricting effect of midodrine may worsen blood flow to affected areas.
- Visual disturbances: Midodrine can cause mydriasis (pupil dilation). Patients with a history of eye problems or those using eye medications should inform their doctor.
- Urinary symptoms: Even in the absence of complete urinary retention, midodrine can cause urinary urgency and difficulty urinating. Patients should report changes in urinary patterns to their doctor.
Your doctor will monitor your blood pressure regularly in both standing and supine positions to ensure the medication is providing adequate benefit while not causing dangerous supine hypertension. Blood pressure monitoring at home is often recommended for patients taking midodrine.
Pregnancy and Breastfeeding
There is limited data on the use of midodrine during pregnancy. Animal studies have shown some evidence of reproductive toxicity at high doses. Midodrine Medical Valley should not be used during pregnancy unless the potential clinical benefit clearly outweighs the risk to the developing fetus. If you are pregnant, think you may be pregnant, or are planning to become pregnant, discuss this with your doctor before starting or continuing treatment.
It is not known whether midodrine or desglymidodrine is excreted in human breast milk. A risk to the breastfed infant cannot be excluded. Your doctor will help you decide whether to discontinue breastfeeding or discontinue midodrine, taking into account the importance of the medication to your health and the benefits of breastfeeding to your child.
Driving and Operating Machinery
Midodrine may cause visual disturbances (including blurred vision from mydriasis) and dizziness in some patients. Orthostatic hypotension itself can cause lightheadedness and fainting that affect the ability to drive safely. Patients should be advised that both the underlying condition and the medication may impair their ability to drive or operate machinery, and they should exercise caution until they understand how midodrine affects them individually.
How Does Midodrine Medical Valley Interact with Other Drugs?
Drug interactions with midodrine are primarily related to its mechanism of action as an alpha-1 adrenergic agonist. Medications that affect blood pressure, heart rate, or the sympathetic nervous system have the greatest potential for clinically significant interactions. It is essential to inform your doctor about all prescription medications, over-the-counter products, and herbal supplements you are taking before starting Midodrine Medical Valley.
Major Interactions
| Interacting Drug | Effect | Clinical Significance |
|---|---|---|
| Alpha-adrenergic blockers (prazosin, doxazosin, tamsulosin) | Directly oppose the vasoconstrictive effect of midodrine, reducing or abolishing its therapeutic benefit | Avoid combination – these drugs work in opposite ways |
| Cardiac glycosides (digoxin) | Enhanced risk of bradycardia (slow heart rate), AV block, and arrhythmias due to additive vagotonic effects | Use with caution; monitor heart rate and ECG closely |
| Beta-blockers (atenolol, metoprolol, propranolol) | Increased risk of bradycardia and enhanced pressor effect (beta-blockade removes beta-2 vasodilation, potentiating alpha-1 vasoconstriction) | Monitor heart rate and blood pressure carefully; dose adjustment may be needed |
| MAO inhibitors (moclobemide, phenelzine, tranylcypromine) | Potentiated pressor response due to reduced catecholamine metabolism; risk of hypertensive crisis | Avoid combination or use with extreme caution under close medical supervision |
| Ergot alkaloids (ergotamine, dihydroergotamine) | Additive vasoconstriction leading to dangerous elevation of blood pressure and peripheral ischemia | Avoid combination |
Minor Interactions
| Interacting Drug | Effect | Clinical Significance |
|---|---|---|
| Fludrocortisone (mineralocorticoid) | Additive blood pressure-raising effect; fludrocortisone promotes sodium and water retention | Often used together therapeutically; monitor blood pressure and watch for supine hypertension |
| Tricyclic antidepressants (amitriptyline, nortriptyline) | Enhanced pressor effect through norepinephrine reuptake inhibition; also may cause orthostatic hypotension independently | Use with caution; complex interaction that may increase supine blood pressure |
| Other sympathomimetics (pseudoephedrine, phenylephrine) | Additive vasoconstriction and blood pressure elevation | Avoid OTC decongestants containing these agents; risk of hypertension |
| Atropine and anticholinergics | Enhanced risk of urinary retention and pupil dilation (mydriasis) | Monitor for urinary symptoms and visual changes |
Midodrine is sometimes combined with fludrocortisone (a mineralocorticoid that increases blood volume) for patients with severe orthostatic hypotension that does not respond adequately to either agent alone. This combination is recognized in clinical guidelines and can be effective, but requires careful monitoring of supine blood pressure, serum potassium levels, and fluid status. Your doctor will determine whether combination therapy is appropriate for your specific situation.
What Is the Correct Dosage of Midodrine Medical Valley?
Midodrine Medical Valley is taken by mouth as a tablet. The dose is individualized based on the severity of orthostatic hypotension symptoms, blood pressure response, and tolerability. Your doctor will start you on a low dose and gradually increase it to find the optimal dose that adequately controls your symptoms without causing unacceptable supine hypertension.
Adults
Standard Adult Dosing
Starting dose: 2.5 mg taken two to three times daily
Dose titration: May be increased in 2.5 mg increments at intervals of at least one week
Usual maintenance dose: 2.5 mg to 10 mg three times daily
Maximum dose: 30 mg per day (10 mg three times daily)
Timing: Take during daytime hours when upright – for example, upon waking, at midday, and in the mid-afternoon. The last dose must be taken at least 3–4 hours before lying down or going to bed.
The timing of doses is critically important with midodrine. Unlike most medications that are taken at fixed intervals throughout the 24-hour day, midodrine must only be taken during waking hours when the patient will be upright. A common dosing schedule is upon arising (e.g., 7:00 AM), at midday (e.g., 12:00 PM), and in the mid-afternoon (e.g., 4:00 PM). The specific timing should be tailored to the patient’s daily routine and when symptoms are most troublesome.
Children
Pediatric Use
Recommendation: The safety and efficacy of midodrine in children and adolescents under 18 years of age have not been established. Use in this population is not recommended unless specifically directed by a specialist physician experienced in pediatric autonomic disorders.
Elderly
Elderly Patients (65 years and older)
Starting dose: 2.5 mg two to three times daily (same as standard adult dose, but titrate more cautiously)
Special considerations: Elderly patients may be more susceptible to supine hypertension and may have reduced renal function affecting drug clearance. Start at the lower end of the dose range and titrate upward slowly with frequent blood pressure monitoring in both standing and supine positions.
Orthostatic hypotension is especially prevalent in the elderly population, and midodrine is frequently prescribed in this age group. However, elderly patients often take multiple medications that can interact with midodrine (including beta-blockers, diuretics, and antihypertensives), and they may have concurrent kidney or liver impairment that affects drug metabolism and elimination. Close monitoring and gradual dose titration are essential to balance the benefits of improved standing blood pressure against the risk of supine hypertension.
Dose Adjustments for Kidney Impairment
Since the active metabolite desglymidodrine is primarily excreted by the kidneys, dose reduction is necessary in patients with impaired renal function. The recommended approach is to start with 2.5 mg and titrate upward cautiously while monitoring blood pressure and kidney function tests. In patients with significantly reduced glomerular filtration rate (GFR), the dosing interval may need to be extended or the maximum daily dose reduced. Midodrine is contraindicated in acute renal disease.
Missed Dose
If you miss a dose of Midodrine Medical Valley, take it as soon as you remember – provided it is still at least 3–4 hours before you plan to lie down or go to bed. If it is too close to bedtime, skip the missed dose entirely and resume your regular dosing schedule the next day. Do not take a double dose to make up for a missed one. Since midodrine has a relatively short duration of action (3–4 hours), missing a single dose may result in a temporary return of orthostatic hypotension symptoms. Take care with position changes during this time.
Overdose
Overdose of midodrine can cause significant hypertension due to excessive alpha-1 receptor stimulation. Symptoms of overdose may include severe high blood pressure, a feeling of coldness, urinary urgency or retention, piloerection (goosebumps), and potentially reflex bradycardia (slow heart rate caused by the body’s response to very high blood pressure). In severe cases, hypertensive emergencies with organ damage can occur.
If overdose is suspected, seek emergency medical attention immediately. Treatment is generally supportive: the alpha-1 blocking agent phentolamine can be administered intravenously to counteract the excessive vasoconstriction. Blood pressure monitoring and supportive care in a hospital setting are essential. There is no specific antidote, but the relatively short half-life of desglymidodrine (approximately 3–4 hours) means that the effects of a single overdose will typically diminish within several hours.
Never take Midodrine Medical Valley within 3–4 hours of bedtime. The blood pressure-raising effect persists for several hours and can cause dangerous supine hypertension when you lie down to sleep. If you work night shifts or have an unusual sleep schedule, discuss the optimal timing of your doses with your doctor.
What Are the Side Effects of Midodrine Medical Valley?
Like all medicines, Midodrine Medical Valley can cause side effects, although not everyone gets them. Many of the side effects of midodrine are directly related to its pharmacological action as an alpha-1 adrenergic agonist and are therefore predictable and dose-dependent. The most important side effect to be aware of is supine hypertension, which requires careful management through proper dose timing and posture.
Clinical trials and post-marketing surveillance have identified the following side effects, organized by how commonly they occur:
Very Common
May affect more than 1 in 10 people
- Piloerection (goosebumps) – caused by alpha-1 stimulation of arrector pili muscles in hair follicles
- Scalp tingling, itching, or pricking sensation (paresthesia of the scalp)
- Supine hypertension (elevated blood pressure when lying down)
Common
May affect up to 1 in 10 people
- Urinary urgency, frequency, or retention
- Nausea and gastrointestinal discomfort
- Headache
- Chills and feeling cold (peripheral vasoconstriction)
- Bradycardia (reflex slowing of heart rate in response to blood pressure elevation)
- Stomatitis (mouth sores or inflammation)
Uncommon
May affect up to 1 in 100 people
- Flushing
- Abdominal pain
- Rash or pruritus (itching)
- Sleep disturbances (insomnia)
- Irritability and restlessness
- Dry mouth
Rare
May affect up to 1 in 1,000 people
- Liver enzyme elevations (hepatic transaminase increase)
- Allergic skin reactions
- Tachycardia (paradoxical fast heart rate)
- Palpitations
Not Known
Frequency cannot be estimated from available data
- Severe hypertension (hypertensive crisis)
- Hypersensitivity reactions including angioedema
- Reflex bradycardia with syncope (fainting due to very slow heart rate)
Managing Supine Hypertension
Supine hypertension is the most significant safety concern with midodrine therapy. It is a pharmacologically predictable effect: midodrine raises blood pressure systemically, and when the patient lies flat, the absence of gravitational pooling in the legs means that central blood volume and blood pressure increase further. The following strategies can help minimize this risk:
- Timing of doses: Take the last dose at least 3–4 hours before lying down or going to bed.
- Elevated head of bed: Sleep with the head of the bed elevated to at least 30 degrees (approximately 15–20 cm elevation of the headboard).
- Blood pressure monitoring: Regularly check blood pressure in both the standing and supine positions. If supine systolic blood pressure exceeds 180 mmHg, contact your doctor for dose adjustment.
- Avoid prolonged lying: Minimize time spent lying completely flat during the hours following a dose.
- Short-acting nitroglycerin or similar agent: In some cases, your doctor may prescribe a short-acting vasodilator to take at bedtime if supine hypertension is problematic.
If you notice severe headache, blurred vision, chest pain, or pounding heartbeat while lying down, sit up immediately and check your blood pressure if possible. Contact your doctor or seek medical attention if symptoms persist.
Reporting Side Effects: If you experience any side effects, including those not listed above, talk to your doctor or pharmacist. You can also report side effects directly to your national drug safety authority (for example, the Yellow Card Scheme in the UK, MedWatch in the US, or the corresponding authority in your country). By reporting side effects, you help provide more information on the safety of this medicine.
How Should You Store Midodrine Medical Valley?
Proper storage of medications ensures they remain effective and safe throughout their shelf life. Midodrine Medical Valley tablets should be stored under the following conditions:
- Temperature: Store below 25°C (77°F). Do not freeze.
- Light protection: Keep the tablets in the original packaging to protect from light, as midodrine may be sensitive to photodegradation.
- Moisture: Store in a dry place. Keep the blister packs sealed until ready to use.
- Children: Keep out of the sight and reach of children. Store in a secure location.
- Expiry date: Do not use Midodrine Medical Valley after the expiry date stated on the carton and blister pack. The expiry date refers to the last day of that month.
Do not dispose of unused or expired medicines via household waste or wastewater. Ask your pharmacist about proper disposal methods in accordance with local regulations. This helps protect the environment.
What Does Midodrine Medical Valley Contain?
Active Ingredient
Each tablet contains 2.5 mg midodrine hydrochloride, equivalent to approximately 2.12 mg of midodrine base. Midodrine hydrochloride is a white to off-white crystalline powder that is freely soluble in water. Its chemical name is (1-(2′,5′-dimethoxyphenyl)-2-glycinamidoethanol hydrochloride), and its molecular formula is C12H18N2O4·HCl with a molecular weight of 290.75 g/mol.
Inactive Ingredients (Excipients)
In addition to the active ingredient, Midodrine Medical Valley tablets contain excipients that serve various purposes in tablet formulation:
- Tablet core: Microcrystalline cellulose (filler/binder), maize starch (disintegrant), magnesium stearate (lubricant), colloidal anhydrous silica (glidant)
- Tablet appearance: The tablets are typically round, white to off-white, and may have a score line to facilitate splitting
If you are allergic to any of the inactive ingredients, inform your doctor or pharmacist before taking this medication. The tablet formulation does not contain gluten, lactose, or sucrose (verify with the product-specific patient information leaflet enclosed in your pack).
Midodrine was first synthesized in the 1960s and has been used clinically for the treatment of orthostatic hypotension since the 1990s. It was approved by the FDA under accelerated approval in 1996 for the indication of symptomatic orthostatic hypotension. The European Medicines Agency and regulatory authorities worldwide have subsequently granted marketing authorization for midodrine-containing products. It remains one of the very few medications specifically approved for the treatment of orthostatic hypotension and is listed in many national formularies including the British National Formulary (BNF) and the WHO Model List of Essential Medicines (complementary list).
Frequently Asked Questions About Midodrine Medical Valley
Midodrine Medical Valley is used to treat symptomatic orthostatic hypotension – a condition in which blood pressure drops significantly upon standing, causing symptoms such as dizziness, lightheadedness, blurred vision, weakness, and fainting (syncope). It is prescribed when non-pharmacological measures (increased fluid and salt intake, compression garments, physical countermaneuvers) have not adequately controlled symptoms. Midodrine raises blood pressure by constricting blood vessels through alpha-1 adrenergic receptor stimulation.
Midodrine begins to raise blood pressure within approximately 30 to 60 minutes after oral administration. The peak blood pressure-raising effect typically occurs 1 to 2 hours after taking the tablet. The effect lasts for approximately 3 to 4 hours, which is why midodrine needs to be taken multiple times per day during waking hours.
Midodrine raises blood pressure by constricting blood vessels. When you lie down, blood redistributes centrally and the blood pressure-raising effect becomes more pronounced, potentially causing supine hypertension (dangerously high blood pressure while lying flat). The last dose should be taken at least 3–4 hours before going to bed. If you need to lie down during the day, elevate the head of the bed to at least 30 degrees.
Yes, midodrine and fludrocortisone are sometimes used together for patients with severe orthostatic hypotension that does not respond adequately to either medication alone. Fludrocortisone is a mineralocorticoid that increases blood volume by promoting sodium and water retention, while midodrine raises blood pressure through vasoconstriction. The combination addresses orthostatic hypotension through two complementary mechanisms. However, this combination requires careful monitoring of blood pressure (especially supine), serum potassium, and fluid balance.
The most common side effects include piloerection (goosebumps), tingling or itching of the scalp, and urinary urgency or retention. These effects are directly related to the alpha-1 adrenergic stimulating action of midodrine and are usually dose-dependent. Supine hypertension (high blood pressure when lying down) is the most clinically important side effect and requires careful management. Other common effects include nausea, headache, and chills. Most side effects can be managed by adjusting the dose.
Midodrine can be used in elderly patients, and orthostatic hypotension is in fact very common in this age group. However, elderly patients may be more susceptible to supine hypertension and often take multiple medications that could interact with midodrine. Treatment should be started at the lowest effective dose (2.5 mg) and titrated cautiously with frequent blood pressure monitoring in both standing and supine positions. Regular follow-up is essential to ensure safe and effective use.
References
- European Medicines Agency (EMA). Midodrine hydrochloride – Summary of Product Characteristics. EMA product database. Updated 2025.
- U.S. Food and Drug Administration (FDA). ProAmatine (midodrine hydrochloride) Prescribing Information. NDA 019815. Revised 2024.
- Brignole M, Moya A, de Lange FJ, et al. 2018 ESC Guidelines for the diagnosis and management of syncope. European Heart Journal. 2018;39(21):1883–1948. doi:10.1093/eurheartj/ehy037
- Shen WK, Sheldon RS, Benditt DG, et al. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope. Journal of the American College of Cardiology. 2017;70(5):e39–e110. doi:10.1016/j.jacc.2017.03.003
- British National Formulary (BNF). Midodrine hydrochloride monograph. NICE/BNF Online. Accessed 2025.
- Lahrmann H, Cortelli P, Hilz M, Mathias CJ, Struhal W, Tassinari M. EFNS guidelines on the diagnosis and management of orthostatic hypotension. European Journal of Neurology. 2006;13(9):930–936. doi:10.1111/j.1468-1331.2006.01512.x
- Izcovich A, González Malla C, Manzotti M, et al. Midodrine for orthostatic hypotension and recurrent reflex syncope: A systematic review. Neurology. 2014;83(13):1170–1177. doi:10.1212/WNL.0000000000000815
- World Health Organization (WHO). WHO Model List of Essential Medicines. 23rd Edition. Geneva: WHO; 2023.
- Low PA, Singer W. Management of neurogenic orthostatic hypotension: an update. The Lancet Neurology. 2008;7(5):451–458. doi:10.1016/S1474-4422(08)70088-7
- Jankovic J, Gilden JL, Hiner BC, et al. Neurogenic orthostatic hypotension: a double-blind, placebo-controlled study with midodrine. The American Journal of Medicine. 1993;95(1):38–48. doi:10.1016/0002-9343(93)90230-M
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This article was written and reviewed by the iMedic Medical Editorial Team, comprising licensed specialist physicians with expertise in cardiology, clinical pharmacology, and autonomic disorders.
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