Midodrine hydrochloride tablets are a clinically common agonist of peripheral α receptors, which has the effect of raising blood pressure and promoting smooth muscle contraction, and is often used clinically to treat hypotension caused by a variety of reasons, and is also a first-line drug for the treatment of stress urinary incontinence in women, but due to its unique pharmacological mechanism, the method of taking drugs when treating different diseases is different, if you do not pay attention to it, it is very easy to lead to a variety of adverse drug reactions, so scientific taking is the key.
Aunt Li, who is more than 50 years old, has always been troubled by one thing, that is, every time she laughs or jumps, there will be leakage of urine, more or less, so every time she goes out, she has to bring a urine pad, which is very inconvenient. Recently, Aunt Li's company has outdoor activities, and to carry out group dance, Aunt Li is afraid of being ugly, and rushes to the hospital for examination. After the hospital examination, Aunt Li was diagnosed with stress urinary incontinence, and the doctor prescribed Midodrin hydrochloride tablets to Aunt Li and instructed Aunt Li to monitor blood pressure and heart rhythm during the period of taking.
Aunt Li's symptoms of urinary leakage after taking the medicine were indeed alleviated a lot, and there was no need to bring urine pads for outing activities, so she forgot the doctor's instructions. After a square dance competition, Aunt Li suddenly felt dizzy, dizzy, and accompanied by panic and chest tightness, friends quickly sent Aunt Li to the hospital, after examination found that Aunt Li's blood pressure has 170mmHg, heart rhythm is only 50 times / minute, but Aunt Li has no history of hypertension in the past, the doctor judged that Aunt Li's symptoms are due to long-term oral midojun tablets, but there is no standard reduction caused, so aunt Li's dosage is halved, while instructing her to always pay attention to changes in blood pressure and heart rhythm, Aunt Lee agreed.
1. What is midodrine hydrochloride? What is its mechanism of action?
Midodrine hydrochloride is a novel adrenaline a1 receptor agonist evolved from methoxamine, which can optionally bind to peripheral a1 receptors to exert corresponding pharmacological effects.
A1 receptors are widely distributed in the body's peripheral tissues, with a particularly abundant distribution on vascular smooth muscle. When midodrine hydrochloride selectively binds to peripheral vascular adrenaline alpha1 receptors, it induces venous vasoconstriction, thereby playing a significant vasopressor role, and due to the increase in peripheral blood pressure, it will lead to an increase in the amount of blood return and peripheral resistance, which will reflexively lead to a slowing of the heart rhythm.
Secondly, the pelvic floor muscle group is also dominated by smooth muscle, when midodrine hydrochloride tablets are combined with a1 receptor on the smooth muscle of the pelvic floor, it will reflexively stimulate somatic motor neurons, while promoting the contraction of pelvic floor muscle groups, thereby increasing urethral resistance, so it can effectively reduce the leakage of urine.
As a new vasopressor drug, midodrine hydrochloride has high bioavailability, and it can exert 93% of the efficacy within 30 minutes of taking it, and the effect is very fast. Secondly, midodrine hydrochloride has little effect on the smooth muscle of the gastrointestinal tract, so it will hardly cause gastrointestinal contraction, causing adverse reactions, and because it only acts on peripheral α1 receptors, it will not affect the central system through the blood-brain barrier, and there is no obvious direct stimulation effect on the heart, and the safety is high. Midodrine hydrochloride in the body needs to be metabolized by the liver into the active ingredient deglycine midodrine before it can play a role, so it has a certain impact on liver function, secondly, midodrine hydrochloride is excreted by the kidneys, and the metabolic time is about 24-36 hours, so it also has a certain risk for patients with abnormal renal function.
Second, where can I buy midodrine hydrochloride? Can it be taken for a long time?
Many readers have gone to the pharmacy to inquire after reading Xiao Wu's article, but they have been told that there is no medicine such as midodrine hydrochloride, so how should they buy it? The answer is that at present, midodrine hydrochloride is a prescription drug, which can only be purchased in the hospital, and it is recommended that patients in need can go to gynecology or cardiology for specialist treatment and use drugs under the guidance of doctors.
If you have long-term urinary incontinence, can midodrine hydrochloride tablets be taken for a long time? The answer is that it can be taken orally in low doses for a long time, but during taking it, it is necessary to monitor blood pressure and heart rhythm, and at the same time to monitor liver and kidney function, and stop the drug immediately if there is an abnormality.
Whether it is the treatment of stress urinary incontinence or refractory hypotension, it is possible to take midodrine hydrochloride tablets orally for a long time, but because midodrine has a strong vasopressor effect, long-term oral administration will often cause abnormal increase in blood pressure, especially when lying flat or sitting, the blood pressure increase is particularly obvious, so if abnormal blood pressure fluctuations are found, they must stop the drug or adjust the dosage in time; secondly, the liver is the main metabolic and activation site of midodrine hydrochloride, and the kidney is the main excretion of its metabolites. Therefore, long-term oral administration may cause liver and kidney function damage, so it is necessary to check the liver and kidney function regularly during taking the drug, and stop the drug immediately if it is abnormal.
Third, pay attention to different uses in the treatment of different diseases
Midodrine hydrochloride is mainly used clinically for the treatment of two diseases, namely hypotension and stress urinary incontinence, and its dosage is obviously different in the treatment of these two diseases.
1. Hypotension
When used to treat hypotension, it is recommended to use adults and adolescents over 12 years old from each time 2.5 mg, 2 times a day, morning and evening to start, during the medication must monitor the patient's blood pressure changes, observe whether the patient has an adverse reaction, if the patient's tolerance to this drug is acceptable, you can increase the drug dose to 5 mg tablets each time, 2 to 3 times a day, and it should be noted that after taking midodrine hydrochloride tablets, you must not immediately lie flat or sit for a long time, you must keep standing for about 1-2 hours, To prevent abnormal fluctuations in blood pressure from causing dizziness, dizziness and other adverse reactions.
2. Stress urinary incontinence
When used to treat stress urinary incontinence, it is recommended that adults 2.5 mg each time, 2 times a day, up to 5 mg each time, 2 times a day, and the maximum dose per day should not exceed 10 mg, during the medication must pay attention to changes in blood pressure, if the condition is stable after the guidance of the doctor can adjust the dose, long-term oral dose can preferably be maintained at 2.5 mg each time, 1 time each time.
Fourth, scientific taking attention to 4 points
As one of the commonly used drugs in clinical practice, although its indications are not many, it is the first-line drug of choice for most patients with stress urinary incontinence, but its mechanism of action is special, so the following points should be paid attention to when taking it.
1. Pay attention to the dosage and dosage method
During the medication midodrine hydrochloride, the patient's blood pressure must be monitored, and the blood pressure in the recumbent, sitting and standing positions should be monitored, and after taking the drug, it must stand for a short period of half an hour or so to prevent blood pressure fluctuations. Secondly, the daily upper limit of midodrine hydrochloride tablets is 10mg, and it must not be overdose, otherwise it will lead to drug-induced hypertension.
2. Pay attention to adverse reactions
There are few adverse reactions to midodrine hydrochloride tablets, most of which are based on mild bradycardia and arrhythmia, and a small number of patients will have allergic reactions to midodrine tablets, itching and rash. Patients with urinary incontinence experience a feeling of incomplete urination during medication, but most are tolerated.
3. Pay attention to special groups
First of all, patients with serious cardiovascular diseases, hypertension, arrhythmia and other diseases are banned; secondly, patients with hepatic and renal insufficiency and abnormal liver and kidney function are used with caution; third, patients with hyperthyroidism, eosinoblastoma, glaucoma, prostate enlargement, urinary retention and other diseases are prohibited; finally, allergies to drug components, pregnant and lactating women are prohibited.
4. Pay attention to the combination with other drugs
When midodrine hydrochloride is combined with the following types of drugs, pay close attention to adverse reactions.
Vasoconstrictive drugs: reserpine, guanidine, thyroxine, tricyclic antidepressants, etc.;
Antihistamines: chlorpheniramine, diphenhydramine, promethazine, chlorpheniramine, etc.;
Slowed heart rate: digitalis, β receptor blockers (metoprolol), etc.
5. Summary
Midodrine hydrochloride, as a first-line drug for the treatment of hypotension and stress urinary incontinence, is the first choice for many patients, but because of its special drug mechanism, it is hoped that everyone will go to a specialized hospital to standardize the use of drugs under the guidance of doctors. Secondly, patients with stress urinary incontinence must not rely only on drug treatment, must combine pelvic floor muscle exercises, while improving their eating and drinking methods, appropriate exercise, so as to get rid of dependence on drugs.
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