Yes, Midodrine may cause high blood pressure when you are lying flat on your back (supine hypertension). This medicine should only be used by people whose low blood pressure affects their day-to-day life and in people who could not be treated successfully with other therapies.

Midodrine may slow down the heart rate slightly. It should be used cautiously when using it with other medicines (beta blockers, digitalis, etc.) which can further slow down the heart rate. Patients should be monitored if they experience symptoms which are suggestive of slow heart rate.

You should not lie down immediately after taking Midodrine because of the risk of supine hypertension (high blood pressure which occurs when you are lying flat on your back). Therefore, it is recommended to take the last daily dose at least 4 hours before bedtime. You can reduce the risk of supine hypertension occurring during the night by elevating the head.

Midodrine takes about 1 hour to show its effects. However, the action lasts for a short time only, the effect persists for about 2-3 hours.

Midodrine should be taken exactly as directed by your doctor. Midodrine is taken orally with or without food. Swallow the tablet as a whole with a glass of water. Usually, it is advised to take the medicine three times a day (morning, midday, and late afternoon [before 6PM]) with a gap of at least 3 hours. Take the last daily dose of Midodrine before an evening meal and at least 4 hours before bedtime.

Midodrine is not advised for patients having allergy to any component of the product, severe heart disease, unusually slow heart rate, high blood pressure, and conditions causing tightening of the arteries. Along with that, treatment with Midodrine should be avoided if the patient has enlarged prostate gland, urinary retention (when the bladder can’t empty properly), pheochromocytoma (tumour of the adrenal medulla), acute or severe kidney disease, overactive thyroid, poor vision as a result of diabetes, and narrow-angle glaucoma (elevated pressure in the eye).

You may need to check your blood pressure and get your kidney and liver function tests done before you start taking Midodrine. Once you begin the treatment, keep a constant track of your blood pressure and heart rate, especially after lying down.

Symptoms of supine hypertension include chest pain, palpitations, shortness of breath, headache, and blurred vision. If you develop these symptoms tell your doctor immediately. The doctor may reduce the dose of Midodrine or may discontinue treatment if the symptoms persists.

Using Midodrine and metoprolol together can make your heart rate considerably slow. Hence, you need to be careful while using both together. If you experience slow pulse, dizziness and fainting, inform your doctor as the dose of these medicines may need to be modified.