Midodrine

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Midodrine
Clinical data
Trade namesAmatine, Proamatine, Gutron, others
Other names2-amino-N-[2-(2,5-dimethoxyphenyl)-2-hydroxy-ethyl]-acetamide
AHFS/Drugs.comMonograph
MedlinePlusa602023
License data
Pregnancy
category
  • AU: C
Routes of
administration		By mouth
ATC code
Legal status
Legal status
Identifiers
  • (RS)- N-[2-(2,5-Dimethoxyphenyl)-2-hydroxyethyl]glycinamide
JSmol)
ChiralityRacemic mixture
  • O=C(NCC(O)c1cc(OC)ccc1OC)CN
  • InChI=1S/C12H18N2O4/c1-17-8-3-4-11(18-2)9(5-8)10(15)7-14-12(16)6-13/h3-5,10,15H,6-7,13H2,1-2H3,(H,14,16) checkY
  • Key:PTKSEFOSCHHMPD-UHFFFAOYSA-N checkY
 ☒NcheckY (what is this?)  (verify)

Midodrine is a

Shire plc, failed to complete required studies after the medicine reached the market.[2][3] In September 2010, the FDA reversed its decision to remove midodrine from the market and allowed it to remain available to patients while Shire plc collected further data regarding the efficacy and safety of the drug.[4] Shire announced on September 22, 2011, that it was withdrawing completely from supplying midodrine and leaving it to several generics to supply the drug.[5]

Medical uses

Midodrine is indicated for the treatment of symptomatic orthostatic hypotension. It can reduce dizziness and faints by about a third, but can be limited by troublesome

low blood pressure when standing found that midodrine increased standing blood pressure more than droxidopa but that midodrine but not droxidopa increased the risk of high blood pressure when lying down.[7] Small studies have also shown that midodrine can be used to prevent excessive drops in blood pressure in people requiring dialysis.[8]

Midodrine has been used in the complications of cirrhosis. It is also used with octreotide for hepatorenal syndrome; the proposed mechanism is constriction of splanchnic vessels and dilation of renal vasculature. Studies have not been sufficiently well conducted to show a clear place for midodrine.[9]

Contraindications

Midodrine is contraindicated in patients with severe organic heart disease, acute kidney disease,

thyrotoxicosis. Midodrine should not be used in patients with persistent and excessive supine hypertension.[10]

Side effects

Headache, feeling of pressure/fullness in the head, vasodilation/flushing face, scalp tingling, confusion/thinking abnormality, dry mouth, nervousness/anxiety and rash.[11]

Pharmacology

Mechanism of action

Midodrine is a

beta-adrenergic receptors. Desglymidodrine diffuses poorly across the blood–brain barrier, and is therefore not associated with effects on the central nervous system
.

Desglymidodrine—a major metabolite

Pharmacokinetics

After oral administration, midodrine is rapidly absorbed. The plasma levels of the prodrug peak after about half an hour, and decline with a half-life of approximately 25 minutes, while the metabolite reaches peak blood concentrations about 1 to 2 hours after a dose of midodrine and has a half-life of about 3 to 4 hours. The absolute bioavailability of midodrine (measured as desglymidodrine) is 93%.[12]

Chemistry

Midodrine is an odorless, white, crystalline powder, soluble in water and sparingly soluble in methanol.[13]

Stereochemistry

Midodrine contains a stereocenter and consists of two

racemate; i.e., a 1:1 mixture of (R)- and (S)-forms:[14]

Enantiomers of midodrine

(R)-midodrine
CAS number: 133163-25-4
(S)-midodrine
CAS number: 133267-39-7

Synthesis

Acylation of

1,4-dimethoxybenzene with chloroacetyl chloride gives the chloroketone 2. The halogen is then converted to the amine 3 by any set of standard schemes, and the ketone reduced to an alcohol with borohydride (4).[15] Acylation of the amino group in this last intermediate with chloroacetyl chloride affords the amide 5. The halogen is then displaced with azide and the resulting product 6 reduced catalytically to the glycinamide, midodrine (7).[16]

Synthesis of midodrine[17][18] See also:[19]

References

  1. ^ "Proamatine- midodrine hydrochloride tablet". DailyMed. Retrieved 14 August 2021.
  2. ^ U.S. proposes withdrawal of Shire hypotension drug, 16 August 2010.
  3. ^ O'Riordan M. "FDA recommends withdrawal of midodrine". Food and Drug Administration. FDA proposes withdrawal of low blood pressure drug [press release]. August 16, 2010. TheHeart.org. Retrieved 1 April 2011.
  4. ^ Midodrine (ProAmatine, generic) Proposed Market Withdrawal – Update 10 September 2010.
  5. ^ Shire plc. "Shire Provides Update on ProAmatine® (midodrine HCl)". www.prnewswire.com.
  6. S2CID 5439767
    .
  7. S2CID 49674644
    .
  8. PMID 15280522
    .
  9. S2CID 207263346
    .
  10. ^ "Midodrine - FDA prescribing information, side effects and uses". Drugs.com. Retrieved 30 June 2022.
  11. ^ "Midodrine (Oral Route) Side Effects - Mayo Clinic". www.mayoclinic.org.
  12. ^ "Midodrine".
  13. ^ "DailyMed - MIDODRINE HCL- midodrine hydrochloride tablet". DailyMed. Retrieved 5 January 2023.
  14. ISBN 978-3-946057-10-9
    , S. 196.
  15. ISSN 1381-1169
    .
  16. ISBN 978-0-12-818656-5
    .
  17. ^ DE 2506110, Zoelss G, "Phenylethanolamine derivs prepn. - by reducing azides, useful as hypertensives", issued 21 April 1983, assigned to Lentia GmbH. 
  18. ^ K. Wismayr et al., AT 241435 ; eidem, U.S. patent 3,340,298 (1965, 1967 both to Chemie Linz Ag).
  19. ^ Zoelss & W. Karl-Anton Ing DE 2523735  (1974 to Lentia GmbH).

External links

Media related to Midodrine at Wikimedia Commons

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