Midodrine for postural hypotension Bramox

Authored by Mr Michael Stewart, 03 May 2017

Patient is a certified member of
The Information Standard

Reviewed by:
Dr Hannah Gronow, 03 May 2017

Taking midodrine will raise your blood pressure to help stop you feeling dizzy or faint. To begin with you will need to be monitored closely to make sure your blood pressure doesn't go too high.

Do not take a dose of midodrine too late in the evening - your last dose of the day should be taken at least four hours before your bedtime.

While being treated with midodrine, try to keep your head raised slightly when lying down in bed, for instance by using extra pillows. This helps to reduce the risk of having high blood pressure when lying down.

Type of medicineAn alpha-adrenergic sympathomimetic medicine (alpha-agonist)
Used forPostural hypotension (low blood pressure when standing) due to autonomic nervous system dysfunction
Also calledBramox®; Gutron® (unlicensed)
Available asTablets

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.

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 breast-feeding.
  • 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.
  • 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.
  • 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.

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 urineLet your doctor know about this
Goosebumps, itchy scalpIf 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 heartburnStick to simple meals - avoid rich or spicy foods
Raised blood pressure when lying downUsing a blood pressure meter at home may help to identify this. Let your doctor know if you have any concerns
HeadacheLet your doctor know if you experience repeated headaches, especially if you also have blurred vision (see below)
Difficulty passing urineLet your doctor know about this
Chills, tingling or itchy skin, skin flushing, skin rash, swollen or painful lining of the mouthIf 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.

  • 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.

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.

Further reading and references

  • Manufacturer's PIL, Bramox® 2.5 mg and 5 mg tablets; Brancaster Pharma Ltd, The electronic Medicines Compendium. Dated November 2016.

  • British National Formulary 73rd Edition (Mar 2017); British Medical Association and Royal Pharmaceutical Society of Great Britain, London.

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