Midodrine oral tablet interactions: A detailed guide

This article describes possible interactions with midodrine oral tablet. Interactions can cause a drug to have a different effect on the body than expected. Interactions can occur due to medications, alcohol, or certain health conditions.

For coupon options for midodrine and to learn more about the drug, including its uses, see this article.

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Boxed warning: Risk of high blood pressure when lying down

Midodrine has a boxed warning for the risk of high blood pressure when lying down. A boxed warning is the most serious warning from the Food and Drug Administration (FDA).

See the end of this article for more information about this midodrine warning.

Other drugs and midodrine

The drugs in the list below may interact with midodrine oral tablet. This article doesn’t include all drugs that may interact with midodrine.

Drug classes or drugs that may interact with midodrine oral tablet include:

• alpha-blockers:
  • drug examples: doxazosin (Cardura), prazosin (Minipress)
  • what might happen: can make midodrine less effective
• beta-blockers:
  • drug examples: atenolol (Tenormin), propranolol (Inderal LA)
  • what might happen: can increase the risk of slow or irregular heartbeat
• decongestants (found in over-the-counter cold and flu remedies):
  • drug examples: phenylephrine, pseudoephedrine (Sudafed)
  • what might happen: can increase the risk of high blood pressure when lying down*
• ergot alkaloids (a type of migraine treatment):
  • drug examples: dihydroergotamine (Trudhesa, Migranal), ergotamine (Ergomar)
  • what might happen: can increase the risk of high blood pressure when lying down*
• monoamine oxidase inhibitors (MAOIs):
  • drug examples: phenelzine (Nardil), selegiline (Emsam, Zelapar)
  • what might happen: can increase the risk of hypertensive crisis (dangerous increase in blood pressure)
• thyroid hormones:
  • drug examples: levothyroxine (Tirosint, Euthyrox), liothyronine (Cytomel)
  • what might happen: can increase the risk of high blood pressure when lying down*
• digoxin (Lanoxin):
  • what might happen: can increase the risk of slow or irregular heartbeat
• droxidopa (Northera):
  • what might happen: can increase the risk of high blood pressure when lying down*
• fludrocortisone
  • what might happen: can increase the risk of high blood pressure when lying down*
• linezolid (Zyvox):
  • what might happen: can increase the risk of hypertensive crisis (dangerous increase in blood pressure)

* Midodrine oral tablet has a boxed warning for this side effect. See the end of this article for more information about this warning.

When to avoid midodrine

Certain health conditions or other factors could increase some risks with midodrine oral tablet. Because of this, doctors may not prescribe midodrine in these cases. These health conditions or other factors are called contraindications.

Here’s a list of midodrine contraindications:

• Severe heart disease. If you have severe heart disease, taking midodrine oral tablet may worsen your condition.
• Acute (sudden or short-term) kidney disease. If you have acute kidney disease, taking midodrine oral tablet may worsen your condition.
• Urinary retention (being unable to empty your bladder fully). If you have urinary retention, taking midodrine oral tablet may worsen your condition.
• Pheochromocytoma (a type of tumor of the adrenal gland). If you have pheochromocytoma, taking midodrine oral tablet may worsen your symptoms.
• High levels of thyroid hormones. If you have high levels of thyroid hormones, taking midodrine oral tablet may worsen your symptoms.
• Severe, ongoing high blood pressure when lying down. If you have high blood pressure when lying down, taking midodrine oral tablet may worsen your symptoms.
• Past allergic reaction to midodrine. If you’ve ever had an allergic reaction to midodrine oral tablet, taking it again may cause another allergic reaction.

Before you start taking midodrine, tell your doctor if anything listed above relates to you. They can recommend whether you should take midodrine.

Alcohol and midodrine

Midodrine oral tablet is not known to interact with alcohol.

But drinking alcohol can worsen the symptoms of orthostatic hypotension (low blood pressure that occurs upon standing up). And this is the condition midodrine is taken to treat. These symptoms can include dizziness and lightheadedness.

If you drink alcohol, talk with your doctor about whether it’s safe to consume it while taking midodrine oral tablet.

Other interactions and midodrine

Interactions can occur with supplements, foods, vaccines, and some lab tests. Below you can learn whether midodrine oral tablet has these interactions.

The information below doesn’t include all other possible interactions with midodrine.

Midodrine and supplements

Before taking midodrine oral tablet, tell your doctor and pharmacist about any herbs you take, as well as vitamins and supplements. Doing so may help you avoid possible interactions.

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If you have questions about interactions that may affect you, talk with your doctor or pharmacist.

Midodrine interactions with herbs

Midodrine oral tablet isn’t known to interact with any herbs. But this doesn’t mean interactions with herbs can’t happen or won’t be identified later.

Because of this, ask your doctor or pharmacist before taking any of these products while taking midodrine oral tablet.

Midodrine interactions with vitamins

Midodrine oral tablet isn’t known to interact with any vitamins. But this doesn’t mean interactions with vitamins can’t happen or won’t be identified later.

Because of this, ask your doctor or pharmacist before taking any of these products while taking midodrine oral tablet.

Midodrine and food

Midodrine oral tablet isn’t known to interact with foods. But this doesn’t mean interactions with foods can’t happen or won’t be identified later.

Because of this, talk with your doctor or pharmacist about what foods you should avoid while taking midodrine oral tablet.

Midodrine and vaccines

Midodrine oral tablet isn’t known to interact with any vaccines. But this doesn’t mean interactions with vaccines can’t happen or won’t be identified later.

Because of this, talk with your doctor or pharmacist before receiving any vaccines while taking midodrine oral tablet.

Midodrine and lab tests

Midodrine oral tablet isn’t known to interact with lab tests. But this doesn’t mean interactions with lab tests can’t happen or won’t be identified later.

Because of this, talk with your doctor or pharmacist before having any tests while taking midodrine oral tablet.

Midodrine and cannabis or CBD

Midodrine oral tablet isn’t known to interact with cannabis (commonly called marijuana) or cannabis products such as cannabidiol (CBD). But this doesn’t mean interactions can’t happen or won’t be identified later.

But cannabis may worsen the symptoms of orthostatic hypotension (low blood pressure that occurs upon standing up). And this is the condition midodrine is taken to treat. These symptoms can include dizziness and lightheadedness. Cannabis may also increase the risk of high blood pressure when lying down,* which is a serious side effect of midodrine.

As with any drug or supplement, tell your doctor before taking cannabis with midodrine.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

* Midodrine oral tablet has a boxed warning for this side effect. See the end of this article for more information about this midodrine warning.

Health factors and midodrine

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Certain medical conditions or other health factors may increase the risk of interactions with midodrine oral tablet. Before taking midodrine, tell your doctor about your health history. They’ll determine whether any midodrine warnings apply and whether this medication is right for you.

These health conditions or other factors might interact with midodrine oral tablet:

• kidney problems
• liver problems
• diabetes
• trouble urinating (for example, due to prostate problems)
• pregnancy or breastfeeding
• past allergic reaction to midodrine*
• severe heart disease*
• acute (sudden or short-term) kidney disease*
• urinary retention (being unable to empty your bladder fully)*
• pheochromocytoma (a type of tumor of the adrenal gland)*
• high levels of thyroid hormones*

* This is a midodrine contraindication. For more information, see the section called “When to avoid midodrine.”

Preventing midodrine interactions

You may be able to help avoid certain interactions with midodrine oral tablet. Before taking this drug, you may want to discuss possible interactions with your doctor and pharmacist.

Things to consider include:

• Whether you drink alcohol or use cannabis.
• Other medications and herbs you take, as well as vitamins and supplements. Your doctor or pharmacist can help you fill out a medication list.
• What to do if you’re prescribed a new drug while taking midodrine oral tablet.

Taking midodrine exactly as prescribed can also help prevent interactions.

What to ask your doctor

If you have questions about midodrine and possible interactions, talk with your doctor.

Questions you may want to ask your doctor include:

• Does my risk of interactions depend on my dose of midodrine oral tablet?
• Do allergy medications interact with midodrine oral tablet?
• Can I take pain relievers with midodrine oral tablet?
• Do other drugs that could treat my condition have similar interactions?

Boxed warning for midodrine

Midodrine has a boxed warning for the risk of high blood pressure when lying down. A boxed warning is the most serious warning from the Food and Drug Administration (FDA).

Midodrine is taken to treat orthostatic hypotension (low blood pressure that occurs upon standing up). It works by increasing your blood pressure. Because of this, it can sometimes cause high blood pressure when lying down. And this can raise your risk of stroke.

Due to this risk, your doctor will usually prescribe midodrine only if:

• other treatments for your condition haven’t worked
• your low blood pressure symptoms significantly affect your daily life
• you don’t already have high blood pressure when lying down

During treatment, your doctor will regularly check your blood pressure while you’re standing, sitting, and lying down.

To help prevent high blood pressure when lying down, it may help to:

• avoid lying completely flat when sleeping
• sleep with the head of your bed raised slightly
• sleep propped up on pillows

If you plan to lie down during the day, your doctor may advise skipping a midodrine dose. And they’ll usually recommend taking your last dose of the day at least 3-4 hours before bedtime. Talk with your doctor about when to take your midodrine doses.

If you have symptoms of high blood pressure when lying down, call your doctor right away. These may include:

• pounding in your ears
• a pounding or racing heartbeat
• blurry vision
• headache

To learn more about this boxed warning, talk with your doctor.

Disclaimer: Optum Perks has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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