Midodrine hydrochloride - Orthostatic hypotension

Midodrine may be considered (2nd line after fludrocortisone) for the treatment of orthostatic hypotension
- due to autonomic dysfunction;  OR
- in patients with Parkinson's Disease
See the Midodrine SPC for details of contraindications and monitoring requirements and information sheet

Midorine should only be initiated on request from a Parkinson's specialist and only after a review of existing medicines to address any potential pharmalogical causes for the hypotension (including antihypertensives, dopaminergics, anticholinergics, antidepressants).

Fludrocortisone, although unlicensed for this use, should be used in preference to midodrine . Again, refer to the SPC for clinical particulars including contraindications and interactions with other medicines

The PCN recommends midodrine (Bramox®) as a treatment option, after fludrocortisone, for the treatment of orthostatic hypotension due to autonomic dysfunction.
A prescribing information sheet is available below.
Midodrine (Bramox) for orthostatic hypotension was assigned a BLUE traffic light status (formerly Amber*). As such, it was agreed as appropriate for primary care prescribing AFTER initiation by a specialist.