Midodrine mechanism?

Midodrine works as a prodrug. It is rapidly converted to its active metabolite, desglymidodrine, which is an alpha-1 adrenergic receptor agonist.

- Mechanism: Desglymidodrine binds vascular smooth muscle alpha-1 receptors, causing constriction of arterioles and veins. This increases systemic vascular resistance and venous return to the heart, raising blood pressure, especially when the patient is upright.
- Key point: The effect is peripheral with limited CNS penetration.
- Clinical relevance: Used to treat orthostatic hypotension by reducing the drop in BP on standing. Monitor for hypertension, including supine hypertension, and time dosing to avoid bedtime dosing.