Midodrin (Midodrinum)

Pharmacodynamics Pharmacokinetics Indications Carefully Contraindications Dosing and Administration Side effects
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Clinical and pharmacological group: & nbsp

Alpha-adrenomimetics

Included in the formulation
АТХ:

C.01.C.A.17   Midodrin

C.01.C.A   Adreno- and dopaminomimetics

Pharmacodynamics:

Alpha-adrenomimetic, has numerous pharmacological effects:

- narrowing of the coronary arteries, vessels of the skin and mucous membranes, skeletal muscles, salivary glands, kidneys, systemic veins of the brain (insignificant), lungs, abdominal cavity organs;

- antiallergic (systemic) - prevention of vasodilation and inhibition of the release of mediators of mast cells;

- increasing the duration of action for local anesthesia by narrowing the vessels and slowing the absorption of local anesthetics;

- decreased peristalsis and tone of the stomach and intestines, reduction of sphincters;

- increased renin secretion;

- reduction of the sphincter of the bladder; increased peristalsis and tone of ureters;

- reduction of the pregnant uterus;

- Reduction of the dilator of the pupil (dilated pupil);

- increased secretion of lacrimal glands;

- increased secretion of K+ and water salivary glands;

- ejaculation in men;

- contraction of muscles that lift hair, increase secretion of sweat glands;

- reduction of the capsule of the spleen;

- increased glycogenolysis and gluconeogenesis in the liver;

- inhibition of secretion of acinous and β-cells of pancreatic islets.

Pharmacokinetics:

Absorption is fast. The connection with plasma proteins is insignificant. Biotransformation in the liver and other tissues to the active metabolite - desglimidodrin. The elimination half-life is 25 minutes. It is excreted by the kidneys, 80% in the form of desglimidodrin. Removed during hemodialysis.

Indications:

- Orthostatic hypotension (with reactions like sympathicotonia and asympathicotonia), idiopathic orthostatic hypotension, secondary orthostatic hypotension, arterial hypotension (on the background of psychoactive drugs, in the period of convalescence after operations and delivery), secondary hypotension in infectious diseases, arterial hypotension in weather changes;

- Urinary incontinence (involuntary urination with dysfunction of the sphincter of the bladder).

ICD-10

IX.I95-I99.I95.1   Orthostatic hypotension

IX.I95-I99.I95   Hypotension

XVIII.R30-R39.R32   Urinary incontinence, unspecified

Contraindications:

Arterial hypertension.

Pheochromocytoma.

Obliterating arterial diseases.

Spasm of peripheral arteries.

Closed-angle glaucoma.

Hyperplasia of the prostate with a delay of urine.

Mechanical obstruction of the urinary tract.

Individual intolerance.

Thyrotoxicosis.

Carefully:

Chronic heart failure.

Arrhythmias.

Renal and / or hepatic insufficiency.

Pregnancy and breastfeeding - appointment is possible only on strict indications.

Pregnancy and lactation:

FDA recommendation category C. Apply during pregnancy and breastfeeding only as directed by the doctor with caution.

Dosing and Administration:

Inside 2.5 mg 2 times a day (1 tablet or 7 drops of 1% solution 2 times a day), if necessary, increase at an interval of 1 week to 5 mg 2 times a day. If a long-term treatment is necessary, the dose can be reduced to 1.25 mg 1-2 times a day (3 drops of 1% solution once a day).

Intravenously 5 mg twice a day. Not more than 30 mg per day.

Side effects:

Klinostaticheskaya hypertension - a sharp rise in blood pressure when going to the prone position.

Systemic action: more often - tachycardia or bradycardia, headache, tremor, anxiety; less often - dizziness, insomnia, sweating, nausea and / or vomiting; rarely - arrhythmias, hypertension or hypotension, anginal pain, hypokalemia, spasms or muscle twitching, oliguria, sleep disorders,psychoneurological disorders (psychomotor agitation, memory impairment, hallucinations, suicidal attempts and other disorders), paradoxical or caused by the hypersensitivity reaction of bronchospasm, allergic reactions, lactic acidosis.

Heartburn, dry mouth, nausea, dyspeptic disorders, flatulence, aphthous stomatitis.

Increased sweating, pilomotornaya reaction ("goose" skin), itching, chills, tenderness of the skin.

Narrowing of the fields of vision.

Overdose:

In case of overdose, hypertension, arrhythmias, transient bradycardia with transition to tachycardia, myocardial infarction, pulmonary edema, renal failure, metabolic acidosis, dyspnea, headache, vomiting, unusual pallor, cold skin, chills, goosebumps, urine retention.

Treatment is symptomatic (maintenance of the condition): atropine in therapeutic doses, α-adrenoblockers.

Interaction:

α-adrenoblockers, other agents with α-adrenergic blocking activity (haloperidol, phenothiazines, thioxanthenes) - decrease of vasoconstrictor effect.

β-Adrenoblockers, including drugs used in ophthalmology, cardiac glycosides - the risk of severe bradycardia with the possible development of cardiac blockade.

Antihypertensive drugs - the antagonism of effects on blood pressure.

Means that cause vasoconstriction (including sympathomimetics) - an additive effect on blood pressure.

Remedies for sodium (fludrocortisone and other means with mineralocorticoid activity) - the risk of hypertension.

Funds eliminated by tubular secretion (cimetidine, flecainide, metformin, procainamide, quinidine, ranitidine, triamterene) - a violation of the elimination of midodrin (desglimidodrina).

Special instructions:

In severe organic lesions of the cardiovascular system, heart rhythm disturbances and kidney function, mandatory correction of dosing is required. Particular attention is paid to the dosage and in the case of treatment of hypotension caused by weather changes, with an indication of hypertension in the anamnesis. With prolonged use or after an intensive course, it is necessary to investigate the function of the kidneys.

Instructions
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