Midodrine, the first FDA-approved drug for orthostatic hypotension, bears the FDA’s strongest warning concerning supine blood pressure elevation - critical for dentists to know before their patient lies down in the chair. Keep reading to learn:
Generic Name: Midodrine Hydrochloride
Brand Name(s): Orvaten, Proamatine
Pronunciation: MY doe drin
About this drug:
Midodrine is used to treat severe hypotension (e.g. orthostatic hypotension).
It may also be used for other medical conditions not listed.
Dentistry-related tidbits:
Midodrine has a Black Box Warning (i.e. the FDA’s strongest warning) concerning elevating blood pressure (> 200 mmHg) when a patient is in a supine or reclined position. Make sure to take the patient's blood pressure and pulse when they are in the supine position in the dental chair. Uncontrolled hypertension increased the risk of cardiovascular events, particularly stroke.
Midodrine can cause xerostomia.
Monitor blood pressure and heart rate when administering local anesthetic with Epinephrine to a patient taking Midodrine as this combination may increase blood pressure and cause cardiac arrhythmias. Avoid Epinephrine if possible, or limit the Epinephrine dose.
Monitor blood pressure when administering the following local anesthetics to a patient taking Midodrine, as the combination may increase the risk of bradycardia: Articaine (Septocaine), Bupivacaine (Marcaine), Lidocaine (Xylocaine), Mepivacaine (Carbocaine), Ropivacaine (Naropin).
Steroids, NSAIDs, and Linezolid can increase the risk of hypertension with Midodrine. Make sure to check for potential interactions before prescribing using a tool like Rx Check.
Fun facts:
Midodrine raises blood pressure by tightening the blood vessels in the body. Its metabolized form, Desglymidodrine, is an alpha-1 adrenergic agonist.
The effects of Midodrine are relatively short-lived, requiring multiple daily doses to maintain its therapeutic benefits.
While primarily indicated for orthostatic hypotension, midodrine is sometimes used off-label in the treatment of other conditions, such as chronic fatigue syndrome and vasovagal syncope.
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