Midodrine’s capacity to maintain blood pressure stability has prompted its off-label application in addressing conditions such as postural orthostatic tachycardia syndrome (POTS) and orthostatic intolerance. These conditions are commonly observed in individuals with Long COVID and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), offering a potential avenue for managing symptoms in these intricate and multifaceted complex conditions.

Midodrine is not right for everyone. Tell your prescribing physician if you have a history of any of the following conditions:

Contraindications associated with the use of midodrine include:

• Liver disease - may interfere with the metabolism of midodrine

• Kidney disease - may worsen urinary retention, or worsen kidney function

• Heart disease, arrhythmias or heart failure

• High blood pressure, hyperadrenergic POTS, hyperthyroidism, thyrotoxicosis or   pheochromocytoma (or otherwise excessive adrenaline, noradrenaline or dopamine) - these disorders put you at risk for hypertension, and midodrine can worsen this hypertension

• Obliterative or spastic vessel disease like Prinzmetal’s angina, Buerger's disease, coronary artery spasms - these disorders put you at risk for hypertension and midodrine can worsen this

• Urinary retention or serious prostate disorder - midodrine can increase urinary retention and worsen these symptoms

• Proliferative diabetic retinopathy or narrow angle glaucoma - midodrine can increase intraocular pressure, worsening these conditions

• Allergy to midodrine or other alpha-1 receptor agonists like apraclonidine, epinephrine, methoxamine, norepinephrine, oxymetazoline, phenylephrine, psuedoephedrine, tetryzoline or xylometazoline.

• Midodrine should be taken as directed throughout the day, with the first dose starting when you wake up.

• The final dose of the day should be taken at least 4 hours before you go to bed. When you lie down after taking midodrine, high blood pressure can occur.

If you miss a dose, take it as soon as possible. If you are close to the time of your next dose, wait to take the next dose and then resume your normal dosing schedule. Do not “double-up” the dose.

While midodrine is safe and generally well-tolerated by patients experiencing a range of conditions, the timing of your dose can be very important. Midodrine can cause supine hypertension (increased blood pressure when lying down), so your final dose of the day should be taken well before bed time. Other potential side effects can include:

• Numbness and tingling sensations

• Goosebumps, chills, shivering or feeling cold

• Changes in urinary habits like frequency, urgency or mild difficulty urinating

• Feeling nervous or anxious

• Headaches

• Nausea or abdominal pain

• Dry mouth

• Difficulty sleeping

• Cramping of the leg muscles

• Itching

Keep this medication in the container provided by the pharmacy. Ensure it is properly closed and out of the reach of children. Store at room temperature and away from excess heat and moisture (not in the bathroom).

Our selected medications are low-risk and research-backed to improve symptoms of chronic complex conditions.

Each medication assessment is approved by a team of expert clinicians and pharmacists, ensuring the highest standards of patient safety.