Midodrine Pharmacology Podcast

Real Life Pharmacology - Pharmacology Education for Health Care Professionals

Eric Christianson, PharmD; Pharmacology Expert and Clinical Pharmacist

Education, Health & Fitness, Medicine

5 • 716 Ratings

🗓️ 2 October 2025

⏱️ 12 minutes

🔗️ Recording | iTunes | RSS

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Summary

Midodrine is an oral alpha-1 agonist most commonly used for the treatment of symptomatic orthostatic hypotension. Its mechanism of action is through peripheral vasoconstriction, which helps increase blood pressure. Because of its short duration of action, it is typically dosed three times daily, with the last dose recommended in the late afternoon to reduce the risk of hypertension at night.

Clinically, midodrine is often considered when non-pharmacologic strategies for orthostatic hypotension (such as increased salt/fluid intake, compression stockings, or physical counter-maneuvers) are not enough. Pharmacists should also be aware of prescribing cascades—such as urinary retention leading to tamsulosin initiation—that can arise when midodrine is used.

Midodrine is generally not metabolized through cytochrome P450 pathways, so significant drug–drug interactions are less common. However, caution should be exercised with other agents that can raise blood pressure (like decongestants) or slow the heart rate (such as beta-blockers). Monitoring parameters include blood pressure, pulse, symptoms of urinary retention, and the patient’s overall response to therapy.

Transcript

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0:00.0	Hey, all, welcome back to the Real Life Pharmacology podcast.
0:03.6	I'm your host, pharmacist, Eric Christensen.
0:05.8	Thank you so much for listening today.
0:08.2	Go check out Real Life Pharmacology.com.
0:11.4	We got a free 31-page PDF on the top 200 drugs.
0:15.5	It's a great study guide, great refresher, things that I see in practice all the time,
0:20.6	as well as things that will likely
0:22.1	show up on pharmacology exams and board exams.
0:25.3	So that free 31 page PDF can be found at real life pharmacology.com.
0:32.0	Simply an email will get you access to that.
0:34.4	It's definitely a no-brainer to go snag that.
0:37.1	We'll also get you updates
0:38.9	when we have a new podcast and other content available as well. So definitely go seek that out
0:46.4	at real-life pharmacology.com. All right, the drug of the day today is midadrine. Brand name of
0:54.0	this medication that I see most often is pro amatine.
0:58.2	I will say at this point, middrains been around a long time,
1:01.1	so that's the more common name that I see utilized, which I'll use here.
1:05.8	It is an alpha-1 adrenergic agonist.
1:18.5	So this is going to have vasopressor-type activities. So basically what it does is it closes or clamps down on those blood vessels. That's going to be the ultimate effect
1:24.2	from this medication. Okay.
1:31.8	So what would that potentially be useful for?
1:37.5	Well, by stimulating those alpha-1 receptors, we're going to cause that vasoconstriction and in a setting like orthostatic hypotension, you know, that's symptomatic and clinically
	...

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