Treatment is generally initiated with lower strengths and adjusted based on clinical response.
 

• The usual initial dosage is 2.5 mg administered two to three times daily.

• Dosage should be increased gradually at weekly intervals until an optimal therapeutic response is achieved.

• The maximum recommended daily dose is 30 mg, divided into three doses.

• The last daily dose should be taken at least four hours before bedtime to reduce the risk of supine hypertension.

• Tablets should be swallowed whole with sufficient water and should not be chewed or crushed.

MIDULA 2.5 should not be used in patients with :
 

• Hypersensitivity to Midodrine or any component of the formulation

• Severe organic heart disease

• Hypertension

• Acute kidney disease

• Severe renal impairment

• Serious prostate disorders

• Urinary retention

• Proliferative diabetic retinopathy

• Pheochromocytoma

• Hyperthyroidism

• Narrow-angle glaucoma

Regular monitoring of standing and supine blood pressure is necessary during treatment.

Caution is advised in patients with :
 

• Severe autonomic nervous system disorders

• Atherosclerotic disease

• Prostate disorders

• Renal impairment

• Hepatic dysfunction

• Bradycardia

Midodrine may interact with :
 

• Sympathomimetics and vasopressor agents

• Tricyclic antidepressants

• Antihistamines

• Thyroid hormones

• MAO inhibitors

• Alpha-adrenergic antagonists

• Digitalis preparations

• Corticosteroids

• CYP2D6 inhibitors such as quinidine, paroxetine, fluoxetine, and bupropion