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By uzma chaudhry
9 Jan 2012
When I saw midodrine prescribed on the drug chart I had to think hard. Did I know this drug? Although it sounded familiar I was sure I had never seen it before. So I checked in the BNF to find one line stating that it can be used for hypotension. There was no other information so I next checked the manufacturers information. And found that it is a sympathomimetic and an alpha agonist. The doctor had precribed 2.5mg twice a day. The SPC stated that the dose can be titrated up as high as 10mg three times a day. It's unlicensed so the consultant had to fill out an unlicensed form before it could be ordered. The patients blood pressure readings were very low; 79/50. So we will see how effective this drug is.

Midodrine information

Hello Uzma

A review of the evidence for midodrine for orthostatic hypotension was produced last year as part of a pilot project about unlicensed and off-label medicines. It can be found on the National electronic Library for Medicines (NeLM) website:

with reviews on bortezomib for relapsed or refractory mantle cell lymphoma; oral pentosan for painful bladder syndrome/interstitial cystitis; oral acetylcysteine for idiopathic pulomary fibrosis. 

The pilot project was well received by the Department of Health and a tender inviting organisations to write more reviews is currently open, so I expect more reviews will be forthcoming.

Documents such as the midodrine one on NeLM are written by pharmacists at UK Medicines Information Centres. Other sources of information include 'Medicines Q&As' answering frequently asked questions, and 'NICE Bites' summarising NICE guidance. It is a good place to look for information and you can register to receive daily e-mails.

Best wishes

Sue Gough

Wessex Drug and Information Centre