Midodrine, an alpha-adrenergic agonist is used primarily for orthostatic hypotension to raise blood pressure. It is not without a spectrum of potential side effects which patients and healthcare providers need to weigh. Piloerection, or goosebumps appeal is infamous side effects experienced by patients ad somewhere between 10-20% of those treated seem to be bothered by it. The drug activates alpha-adrenergic receptors, which in turn make smooth muscles just beneath hair follicles to shrink.
One of the major drawbacks to midodrine is its effects on blood pressure; SUPINE HYPERTENSION: Clinical trials have revealed that 5-15% of patients will develop supine hypertension – a dangerous increase in blood pressure when lying down. This is risky because we know that hypertension puts a senior at higher risk of developing cardiovascular events, and elderly hypertensive patients are more vulnerable than younger ones.
The other common side effect which is reported for the drug as well, urinary retention would have an incidence of about 7–10%. This happens because midodrine has an action on the smooth muscle of your bladder resulting in a decreasing clearance rate (you cant pee!!!) Consequently, patients with pre-existing urinary conditions and benign prostatic hyperplasia (BPH) should avoid midodrine or take it cautiously.
In addition, nearly 12% of participants receiving midodrine therapy reported headaches in a study by Wallbach et al [31] published in The Journal of Hypertension (2016). These are thought to relate in some way (nobody knows for sure) to this drug's vasoconstrictive properties, which might then lead reduced blood flow areas of the brain. Although not overly serious, these headaches may be severe enough that they warrant a reduction in dose or cessation of the drug.
Another common side effect, this time reported by approximately 5% of midodrine users, is pruritus -- i.e. itching. This side effect often occurs with piloerection and can be severe in subjects with delicate skin, or underlying dermatological conditions.
A few reports have characterized bradycardia associated with midodrine, but only in rare cases. This affects fewer than 2% of users but is particularly alarming for individuals with preexisting cardiovascular conditions that may naturally lead to bradycardia. A case from 2019 illustrated the development of profound bradycardia within two weeks after initiating midodrine, compelling discontinuation.
The side effects of Midodrine also support the need for ongoing monitoring, especially in patients with other cardiovascular risks. To learn more about midodrine side effects, check out the link: Midodrine Side Effects.