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GUTRON (midodrine hydrochloride) tablets may be added to an established treatment regimen in order to attenuate symptoms in the primary neurogenic types of idiopathic orthostatic hypotension, that is in the Bradbury-Eggleston or Shy-Drager syndromes, in those cases when the response to the standard therapy is not adequate.

Dosage and Administration
Adults and Adolescents: Treatment with GUTRON (midodrine hydrochloride) tablets should be started under close medical supervision in a controlled clinical setting such as in hospital, in the clinic, or in the office. Hourly measurements of blood pressure (supine and sitting or standing, if possible) should be made for 3 hours following the first dose and also the second dose of a three times daily dosage regimen.

It is recommended that treatment begin at the lowest level and be titrated at intervals of three to several days until the optimal response is obtained. Upon escalating the dosage, the supine and standing blood pressure should be closely monitored in hospital, in the clinic or in the office as for the initiation of therapy, hourly for 3 hours following the first two doses.

The usual starting dose of GUTRON tablets is 2.5mg three times daily. Single doses of 2.5, 5 and 10mg have been successfully employed. Most patients are controlled at or below 30mg per day given in three or four divided doses. GUTRON tablets can be given up to six times per day.

Some patients require a morning dose that is higher than that taken later in the day. In some instances GUTRON tablets have been given on a three times per day schedule as follows: 1 to 2 hours before arising in the morning, mid-morning and mid-afternoon. In order to reduce the potential for supine hypertension, it is recommended that midodrine doses not be given after the evening meal. The maximum recommended dose should not exceed 30mg daily.

During the period of close medical supervision, the patient or a relative should be trained to measure blood pressures. Supine and sitting blood pressures should be measured daily for at least a month after initiation of treatment and twice per week afterwards.

The administration of GUTRON tablets should be stopped and the attending physician notified immediately, if the blood pressure in either position increases above 180/100mmHg.

Children: In view of the lack of experience in children, this medicine is not recommended for patients under 12 years of age.

Contraindications
Midodrine is contraindicated in patients with severe organic heart disease, acute renal failure, urinary retention, pheochromocytoma, thyrotoxicosis or known hypersensitivity to midodrine.