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Midodrine is a medication that requires careful consideration before use due to its significant impact on blood pressure and potential interactions with other health conditions. Below are important safety warnings and guidelines to ensure its safe administration:

• Blood Pressure Increase When Lying Down: Midodrine can significantly elevate blood pressure when you are lying down. This can be dangerous, leading to blood pressure levels above 200 mmHg. Therefore, avoid taking midodrine if you are planning to lie down. It should only be used if orthostatic hypotension severely impacts your daily activities and other treatments have not been effective. Alert your healthcare provider if you experience a rapid heartbeat, pounding in the ears, headaches, or blurred vision after taking midodrine in a lying position. Discontinue use if these symptoms persist.

• Slow Heart Rate: This medication may reduce your heart rate. Discuss with your healthcare provider before starting if you are on other medications that also lower heart rate, such as digoxin, beta blockers, or certain antidepressants. Report any symptoms like a slow pulse, dizziness, faintness, or irregular heartbeat to your provider.

• Pre-existing Health Conditions: Since midodrine constricts blood vessels, it may exacerbate certain medical conditions. Those with existing urination difficulties may experience worsening symptoms, as midodrine affects blood vessels in the bladder neck. It can also impact eye health, particularly in diabetic patients or those with a history of eye issues, especially if taking fludrocortisone, which can increase eye pressure and risk of glaucoma. Patients with kidney or liver problems should also exercise caution.

• Contraindications: Midodrine should not be used in individuals with severe heart conditions, sudden onset kidney problems, urinary retention, pheochromocytoma (a rare adrenal gland tumor), thyrotoxicosis (excess thyroid hormone), or those who frequently experience high blood pressure when lying down. Consult with your healthcare provider if any of these conditions apply.

Always discuss any concerns or symptoms with your healthcare provider to ensure the safe use of midodrine. In case of an overdose or severe adverse reaction, seek emergency medical assistance immediately.

Common side effects:

• Tingling sensation in the skin
• Chills
• Goosebumps
• Stomach pain
• Strong urge to urinate
• Frequent urination
• Difficulty urinating

Less common but important to monitor:

• Dry mouth
• Dizziness
• Drowsiness
• Trouble sleeping
• Leg cramps
• Supine hypertension
• Pounding heartbeat
• Pounding in the ears
• Headache
• Blurred vision

Serious side effects:

• Slow heartbeat
• Unusual chest sensations
• Fainting
• Pressure or fullness in the head
• Confusion
• Anxiety
• Weakness
• Vision problems
• Severe allergic reaction
• Rash
• Itching
• Swelling (especially of the face, tongue, or throat)
• Severe dizziness
• Trouble breathing

Interactions with high risk of serious adverse effects and should be avoided:

• Dihydroergotamine
• Tranylcypromine

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Deslanoside
• Digitoxin
• Droxidopa
• Ephedrine
• Furazolidone
• Iobenguane I 123
• Iobenguane I 131
• Iproniazid
• Isocarboxazid
• Levothyroxine
• Linezolid
• Liothyronine
• Methylene Blue
• Moclobemide
• Nialamide
• Phenelzine
• Phenylephrine
• Phenylpropanolamine
• Procarbazine
• Pseudoephedrine
• Rasagiline
• Safinamide
• Selegiline
• Thyroid
• Toloxatone

Interactions with low risk that usually do not require a change in therapy:

• Perphenazine
• Promethazine
• Risperidone