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Brighton and Hove CCG
High Weald Lewes Havens CCG
Brighton and Sussex University Hospitals NHS Trust
BLUE Information Sheet
Drug Name: Midodrine
INDICATION/S COVERED (including whether for adults or children):
Treatment of severe orthostatic hypotension due to autonomic dysfunction where corrective factors have been
ruled out and other forms of treatment are inadequate. Only licensed for adults.
Traffic Light System classification – Blue
Blue: Drugs that are considered suitable for prescribing in primary care, following initiation by a specialist as monitoring and skills required for prescribing
are deemed less complex, there is more widespread experience of prescribing in primary care and primary care prescribers are generally happy to prescribe
on specialist advice without the need for formal shared care. A minimum of one months’ supply of medication should be prescribed by the initiating
consultant, even if prescribing responsibility is transferred earlier than this. A primary care prescriber must be familiar with the prescribing responsibilities
and where a primary care prescriber has no experience of prescribing then adequate additional information should be provided by the initiating specialist.
This information sheet should be sent to the primary care prescriber with the clinic letter.
RESPONSIBILITIES and ROLES
Consultant / Specialist responsibilities
1.
2.
3.
Diagnosis
To assess the suitability of patient for MIDODRINE treatment
To discuss the aims, benefits and side effects of treatment with the patient as well as their role.
The most common side effects are piloerection, pruritus of the scalp and dysuria.
If patients experience dizziness or light-headedness they should refrain from operating machinery or driving.
Advise the patient to report symptoms of supine hypertension (chest pain, palpitations, shortness of breath, headache or
blurred vision).
Advise patient that the risk of supine hypertension may be reduced by elevating the head of the bed
4. Explain to the patient their treatment plan including the dosing schedule.
Specifically the patient should be advised not to take doses late in the evening. To reduce the risk of supine hypertension the last
daily dose should be taken at least 4 hours before bedtime.
5. Baseline monitoring undertaken (specific to drug) :
Supine and standing blood pressure should be taken, recorded and communicated to the GP in the clinic letter
Baseline renal function (contra-indicated if creatinine clearance < 30ml/minute) and liver function (no data in hepatic impairment) to
be checked
Heart rate should be checked, recorded and communicated to the GP in the clinic letter (may cause bradycardia)
6. To initiate therapy by prescribing for a minimum of 1 month
7. Monitor and evaluate response to treatment, including adverse drug reactions, with the patient and to continue / discontinue treatment in line
with agreed treatment plan
8. Discuss the possibility of shared care with the patient and ensure they understand the plan for their subsequent treatment.
Inform that patient that they will be able to obtain further prescriptions from their GP
9. Supply GP with summary of patient review (including anticipated length of treatment) and a copy of the information sheet recommending that
a shared care arrangement is initiated.
10. Advise GP if treatment is to discontinue at any point
11. Inform GP if patient does not attend planned follow-up
Primary care prescriber responsibilities
1.
2.
3.
4.
5.
Subsequent prescribing of MIDODRINE at the dose recommended.
Ensure the patient understands not to take doses late in the evening ( last daily dose should be taken at least 4 hours before
bedtime)
Monitor supine and standing blood pressure at least every three months
If patient reports symptoms of supine hypertension (chest pain, palpitations, shortness of breath, headache or blurred vision) the
dose of midodrine can be adjusted downwards. If unsure the GP should contact the initiating consultant for advice.
If supine hypertension is not overcome by reducing the dose treatment with midodrine must be stopped
Check for drug interactions before prescribing any other medication with midodrine
Inform consultant/specialist if treatment is reduced or stopped
Patient / Carer role
1.
2.
3.
4.
5.
Ask the consultant / specialist or primary care prescriber for information, if he or she does not have a clear understanding of the treatment.
Share any concerns in relation to treatment with MIDODRINE.
Tell the consultant / specialist or primary care prescriber of any other medication being taken, including over-the-counter products.
Read the patient information leaflet included with your medication and report any side effects or concerns you have to the consultant /
specialist or primary care prescriber.
Report symptoms of supine hypertension immediately to GP: symptoms typically are chest pain, palpitations, shortness of
breath, headache or blurred vision.
If supine hypertension is not overcome by reducing the dose treatment with midodrine must be stopped
BACK-UP ADVICE and SUPPORT
Telephone No.
Email address:
Specialist:
Hospital Pharmacy:
Other:
This information sheet does not replace the SPC, which should be read in conjunction with this guidance. Prescribers should also refer
to the appropriate paragraph in the current edition of the BNF. The primary care prescriber has the right to refuse to agree to shared care,
in such an event the total clinical responsibility will remain with the consultant / specialist.
Brighton APC - approved September 2016
1
Author Alison Warren, Consultant cardiac pharmacist
For review September 2018