Midodrine Dependency?

[galatea]

I came off Midodrine 3 weeks ago after feeling no improvement with it, but now I have more tachycardia and blood pooling than ever before. I’m wondering if this could be because of dependency on it or that it was actually helping me, but that I’ve just got worse over time? Any theories or similar experiences?

[E Soskis]

I don't know anything about dependency per say - I know I can't do without midodrine. Daily dosages fluctuate up and down depending upon how I feel and how close or far away from plasma exchanges I am - or if I have had to be upright longer one day than another - etc.....I have noticed that over time, it is taking a little longer for the midodrine to kick-in and start working - I would call that "tolerance" to the drug rather than "dependency".........

[Becia]

I definetely have to have my midodrine, or i am a non functioning mess it seems. But ever since ive been on it, it doesnt seem to last as long in me as it does it others... i get about 2 hours of being able to be up and going, as compared to 4-5, and it takes about an hour of that just to kick in.

[galatea]

Thanks for the replies. What you say about the effects wearing off sounds familiar. When I first started, each time I would increase the dose I would feel slightly better that day, but after that no difference.

[Becia]

There was a day that I was completely off of my midodrine, the day after I got out of the hospital. We were having to get a different prescription because I could not swallow the 10 mg the doctor had originally given me. So while I was waiting for them to get enough of the 5 mg, I basically tried to get through my day without it. Even though it does not seem very effective for me, I am under the assumption with many things that some is better than none. Before I never really thought the midodrine working, but after that horrible day I could really tell.

[looneymom]

Our cardiologist tried cutting Tyler's doesage of midodrine in half. Bad mistake, his blood pressure dropped to 80/ 45. Tyler cannot do without his midodrine. He is very tired and has less energy.

Rachel

[rubytuesday]

I have been on Midodrine for several years. I had to have a cardiac pacemaker implanted about a year ago. It is set to function on demand. I asked my cardiologist about the need to continue with the Midodrine since I now have the pacer. At that time, he did my first pacer check and it was doing >63% of the work of the upper heart. He told me he wanted me to continue the medication 'for now' but that I might possibly be able to come off of it some day. I have not had any syncope since the pacer was put in, but I have caught the BP dropping a few times before I felt the pacer--but I get similar symptoms when the BP suddenly jumps high. I was at a doctor appointment about a month ago and the BP was up 146/98. That is high for me (who'd always had the orthostatic hypotension). I hadn't even taken my morning dose of Midodrine that day. My cardiologist never liked my diastolic to go higher than 90 when he was experimenting with medications. Fearing the high diastolic I just quit taking my Midodrine. (I will take it if I am going to attend worship service or go someplace that I may have to stand in line for awhile). I really don't notice any difference. I plan to bring it up when I see my cardiology specialist in a few weeks. I am not sure if it's because of the pacemaker helping sense when the BP falls too low and speeds the heart rate into tachy mode or if it is because I've learned to avoid triggers and we are in cold weather here or if I've just been lucky. It is not something I would have done without discussing with my cardiologist first, but I knew the appointment was upcoming so I thought since I know it goes high abruptly (and don't know how high or how often it goes high, I just thought I would test the waters). I have 2 doctor appointments this week and am curious to see how it reads at both (one is the same doctor where it was high a month ago). I still don't have energy but I didn't while on the Midodrine either--I think because all the boughts of tachycardia and BP ups and downs must make me feel like I'd had an aerobic workout all the time.

I did not experience any effects of withdrawal from the Midodrine but I cut it back by one daily dose for several days, then 2 doses for several days and then to 0 doses/day.

That was my experience and we all come to the table with our unique co-morbidities and medication combinations. I would really suggest that first and foremost you talk it over with your physician.

[ramakentesh]

Midodrine can actually sensitize alpha 1 receptors over time and allow for norepinephrine stores to be increased in sympathetic presynaptic vessicles, both of which would or should result in overall improvement to orthostatic intolerance syndromes.

I know of patients who after taking midodrine for a long period, wheened off and were normal. So they did not become dependent and in fact improved behind the scenes while on it.

For me personally midodrine and phenylephrene dont really help that much with fatigue alwasy but definately with dizziness. The only med that has touched my fatigue is pseudoephedrine but Im not a hugely tachy POTS patient so I can tolerate it ok.