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[Pharmacology](https://durgical.com/en/pharmacology/) · [Vasopressors and inotropes](https://durgical.com/en/pharmacology/classes/vasopressors-and-inotropes/)

# Midodrine

An oral prodrug of an alpha-1 agonist for disabling orthostatic hypotension. Its main risk is high blood pressure when lying down.

Updated 2026-11-01

- Class: [Vasopressors and inotropes](https://durgical.com/en/pharmacology/classes/vasopressors-and-inotropes/)
- Receptor: Alpha-1 adrenergic receptors (through desglymidodrine)
- ATC code: C01CA17

◎**Alpha-1 adrenergic receptors (through desglymidodrine)**Midodrine

ⓘ No structure of desglymidodrine bound to its receptor is available; the figure shows noradrenaline in the same binding site of the human alpha-1A adrenergic receptor.

**Target in 3D:** Alpha-1 adrenergic receptors (through desglymidodrine). PDB structure 7YMH (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/7YMH) · Drag to rotate · pinch to zoom

## Mechanism of action

Midodrine is a prodrug: it is converted in many tissues to desglymidodrine, an alpha-1 agonist. Activating alpha-1 receptors in arterioles and veins raises vascular tone and blood pressure, especially when standing. It has little effect on heart rate and does not enter the brain much.

- Midodrine is converted to desglymidodrine
- Desglymidodrine stimulates alpha-1 receptors in arterioles and veins
- Vascular tone and standing blood pressure rise

## Pharmacokinetics

**Absorption**
Oral; rapidly converted to the active metabolite

**Metabolism**
Deglycination in many tissues; partly metabolised by the liver

**Elimination**
Desglymidodrine is excreted by the kidneys and is dialysable

**Half-life**
Prodrug about 25 minutes; desglymidodrine about 3 to 4 hours (label)

## Indications

- Symptomatic orthostatic hypotension that seriously impairs daily life despite standard care

## Adverse effects

### Common

- Supine hypertension
- Tingling and itching, mainly of the scalp
- Goosebumps and chills
- Urinary urgency, frequency or retention

### Serious (rare, important)

- Marked supine hypertension
- Slow heart rate (bradycardia)

## Contraindications

- Severe organic heart disease
- Acute kidney disease
- Urinary retention
- Pheochromocytoma
- Thyrotoxicosis
- Persistent and excessive supine hypertension

## Key interactions

**Other vasoconstrictors (phenylephrine, ephedrine, pseudoephedrine, dihydroergotamine) and thyroid hormones**
Higher risk of hypertension

**Cardiac glycosides, beta blockers and other drugs that slow the heart**
Bradycardia, AV block or arrhythmia

**Fludrocortisone**
Caution: supine hypertension and raised intraocular pressure

## What is monitored

- Blood pressure lying, sitting and standing
- Heart rate
- Kidney and liver function before and during treatment
- Urinary symptoms

## Nursing care

- Doses are taken during the day, while upright; the last one several hours before bedtime, to limit high pressure when lying down.
- Teach to report pounding in the ears, headache, blurred vision or a slow pulse.
- Sleep with the head of the bed raised if supine hypertension occurs.
- Ask about urinary retention before starting.

## Pregnancy and breastfeeding

Human data are lacking; it is used in pregnancy only if the benefit justifies the risk.

## Memory aid

MIDOdrine: MIDday pills, never at bedtime (supine hypertension).

## Test yourself

Think of the answer, then tap the question to see it.

## What is the active form of midodrine?

Desglymidodrine, an alpha-1 agonist formed by deglycination of the prodrug.

## Why is the last daily dose of midodrine taken well before bedtime?

To avoid supine hypertension, its main risk, when the patient lies down at night.

## Why do patients on midodrine get goosebumps and scalp itching?

Desglymidodrine stimulates alpha-1 receptors of the hair follicles (pilomotor reactions).

## Why is midodrine contraindicated in urinary retention?

Alpha-1 stimulation of the bladder neck increases outflow resistance and can worsen retention.

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## Related drugs

- [Phenylephrine](https://durgical.com/en/pharmacology/phenylephrine/)
- [Norepinephrine](https://durgical.com/en/pharmacology/norepinephrine/)

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [DailyMed - MIDODRINE HYDROCHLORIDE tablet](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=aec0d2de-ce83-b7c2-5d10-740607d50521) (DailyMed (U.S. National Library of Medicine), 2026); [Midodrine: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a616030.html) (MedlinePlus (U.S. National Library of Medicine), 2021); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=C01CA17) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.

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