Midodrine

Midodrine

Clinical data
ATC code	C01CA17 (WHO)
Identifiers
IUPAC name 2-amino-N-[2-(2,5-dimethoxyphenyl)-2-hydroxy-ethyl]-acetamide
CAS Number	133163-28-7
PubChem CID	4195
DrugBank	APRD01116
E number	{{#property:P628}}
ECHA InfoCard	{{#property:P2566}}
Chemical and physical data
Formula	C12H18N2O4
Molar mass	254.282 g/mol

WikiDoc Resources for Midodrine
Articles
Most recent articles on Midodrine Most cited articles on Midodrine Review articles on Midodrine Articles on Midodrine in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Midodrine Images of Midodrine Photos of Midodrine Podcasts & MP3s on Midodrine Videos on Midodrine
Evidence Based Medicine
Cochrane Collaboration on Midodrine Bandolier on Midodrine TRIP on Midodrine
Clinical Trials
Ongoing Trials on Midodrine at Clinical Trials.gov Trial results on Midodrine Clinical Trials on Midodrine at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Midodrine NICE Guidance on Midodrine NHS PRODIGY Guidance FDA on Midodrine CDC on Midodrine
Books
Books on Midodrine
News
Midodrine in the news Be alerted to news on Midodrine News trends on Midodrine
Commentary
Blogs on Midodrine
Definitions
Definitions of Midodrine
Patient Resources / Community
Patient resources on Midodrine Discussion groups on Midodrine Patient Handouts on Midodrine Directions to Hospitals Treating Midodrine Risk calculators and risk factors for Midodrine
Healthcare Provider Resources
Symptoms of Midodrine Causes & Risk Factors for Midodrine Diagnostic studies for Midodrine Treatment of Midodrine
Continuing Medical Education (CME)
CME Programs on Midodrine
International
Midodrine en Espanol Midodrine en Francais
Business
Midodrine in the Marketplace Patents on Midodrine
Experimental / Informatics
List of terms related to Midodrine

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Midodrine (brand names Amatine, ProAmatine, Gutron) is a vasopressor/antihypotensive agent. Midodrine was approved in the United States by the Food and Drug Administration (FDA) in 1996 for the treatment of dysautonomia and orthostatic hypotension. In August 2010, the FDA proposed withdrawing this approval because the manufacturer, Shire plc, has failed to complete required studies after the medicine reached the market.

In September 2010, the FDA reversed its decision to remove Midodrine from the market and has allowed it to remain available to patients while Shire plc collects further data regarding the efficacy and safety of the drug. Shire plc announced on September 27, 2011 that it was continuing the process to work with the FDA towards a final approval of the drug.

Chemical properties

Midodrine is an odorless, white, crystalline powder, soluble in water and sparingly soluble in methanol.

Mechanism of action

Midodrine is a prodrug which forms an active metabolite, desglymidodrine, which is an α₁-receptor agonist and exerts its actions via activation of the alpha-adrenergic receptors of the arteriolar and venous vasculature, producing an increase in vascular tone and elevation of blood pressure. Desglymidodrine does not stimulate cardiac beta-adrenergic receptors. Desglymidodrine diffuses poorly across the blood–brain barrier, and is therefore not associated with effects on the central nervous system.

File:Desglymidodrine.svg

Metabolite desglymidodrine

Metabolism

After oral administration, midodrine is rapidly absorbed. The plasma levels of the prodrug peak after about half an hour, and decline with a half-life of approximately 25 minutes, while the metabolite reaches peak blood concentrations about 1 to 2 hours after a dose of midodrine and has a half-life of about 3 to 4 hours. The absolute bioavailability of midodrine (measured as desglymidodrine) is 93%.

Indications

Midodrine hydrochloride tablets are indicated for the treatment of symptomatic orthostatic hypotension. In a critical care setting, it is widely used as an adjunctive therapy to weaning patients off of intravenous vasopressive medications. It has been suggested also as a treatment for chronic fatigue syndrome as well as for hepato-pulmonary syndrome. It is also used with octreotide for hepatorenal syndrome; the proposed mechanism is constriction of splanchnic vessels and dilation of renal vasculature.

Contraindications

Midodrine is contraindicated in patients with severe organic heart disease, acute renal disease, urinary retention, pheochromocytoma or thyrotoxicosis. Midodrine should not be used in patients with persistent and excessive supine hypertension.

Side effects

Headache; feeling of pressure/fullness in the head, vasodilation/flushing face, confusion/thinking abnormality, dry mouth; nervousness/anxiety and rash.

External links

• Midodrine at drugs.com