Midodrine mode of action?

Question

Accepted Answer

Midodrine is a prodrug. It is rapidly converted to desglymidodrine, the active metabolite.
Mechanism: desglymidodrine is a direct-acting alpha-1 adrenergic receptor agonist.
Effect: stimulates vascular smooth muscle in arterioles and veins → vasoconstriction, increased systemic vascular resistance and venous return → raises blood pressure, especially when upright.
Therapeutic use: treatment of orthostatic hypotension (often due to autonomic dysfunction).
Pharmacodynamics: tends to cause a rise in standing BP with less effect on heart rate (reflex changes may occur; some patients get mild tachycardia/bradycardia).
Pharmacokinetics: onset within about 10–15 minutes after dose; peak effect in about 1–2 hours; duration roughly 2–4 hours per dose; hepatic metabolism to desglymidodrine.
Important cautions: risk of supine hypertension; dosing is timed to daytime hours and not near bedtime. Monitor BP and for adverse effects (headache, gooseflesh, urinary retention, piloerection).

If you want, I can summarize dosing guidelines or common side effects.

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