Midodrine and POTS/ Dysautonomia
- slaters089
- Sep 27, 2024
- 2 min read
Updated: Dec 8, 2025
If you or a loved one are living with a form of dysautonomia, know that you are not alone in facing its challenges. Dysautonomia can disrupt daily life through a wide range of symptoms, making everyday activities difficult. However, with a combination of medication and lifestyle changes, many people find their symptoms become more manageable.
In this blog post, we will explore midodrine—how it works and how it can help individuals with POTS.
What is POTS?
First, let’s define POTS. Postural Orthostatic Tachycardia Syndrome (POTS) is a condition that falls under the umbrella of dysautonomia—a group of disorders related to dysfunction of the autonomic nervous system. The term “autonomic” refers to the self-governing nature of this system, which controls involuntary functions that we do not consciously regulate. These include breathing, digestion, heart rate, blood pressure, body temperature, sweating, and more.
How Does Midodrine Work?
Midodrine is a medication that belongs to a class of drugs called alpha-1 adrenergic agonists. It works by activating alpha-1 receptors in the blood vessels, causing them to constrict or narrow. This results in elevated blood pressure and offers several benefits:
Counteracting orthostatic hypotension: When you stand up, your body's natural response is to increase blood pressure to maintain blood flow to the brain. Midodrine helps to stimulate this response, reducing the likelihood of fainting.
Increased blood volume: By constricting blood vessels, midodrine increases blood volume and thereby increases blood pressure.
Increase cardiac output: Midodrine also increases the heart's pumping efficiency, which further contributes to increased blood pressure.
Dosage
Typically, midodrine is started at 2.5 mg three times daily. The dose can be increased to 5-7.5 mg if needed. It is usually taken every four hours.
Sometimes, midodrine is prescribed to be used "as needed," especially if symptoms are triggered by stressors such as infections or during certain phases of the menstrual cycle.
If your blood pressure varies, it’s important to measure it about 30 minutes before taking midodrine. Ideally, your blood pressure should be below 135/85 mm Hg.
How Midodrine Helps People With POTS?
For individuals with POTS, managing low blood pressure symptoms is a key component of their treatment plan. Midodrine can aid in stabilizing blood pressure, helping to lessen the severity of symptoms—especially during physical activities or periods of exertion.
Common Side Effects
Midodrine may cause tingling sensations in the scalp and hair follicles due to blood vessel constriction. It can also affect the bladder, leading to urinary retention, which may manifest as difficulty starting urination or changes in urination frequency.
Conclusion
In conclusion, midodrine can be an effective treatment option for managing symptoms of POTS. By increasing blood pressure and reducing orthostatic intolerance, midodrine can help reduce symptoms such as dizziness, lightheadedness, and fatigue, allowing individuals to lead more active and comfortable lives.
Midodrine is often used in conjunction with ivabradine.
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