1 What Is Orvaten?

Brand: Orvaten, Proamatine

Generic: Midodrine

Orvaten (Midodrine) is a prescription drug used to treat hypotension, or low blood pressure. It  is also used in the treatment of dizziness, which is usually caused when one stands or sits, especially if they are suffering from orthostatic hypotension. Orvaten can also be prescribed for patients suffering from chronic fatigue syndrome, wherein there are symptoms such as pain in the muscles, depression, fatigue, or low stamina.

Orvaten is comprised of midodrine hydrochloride, which is the active ingredient. It is available in various strengths, such as 2.5mg, 5mg, and 10mg. It stimulates the nerve endings in blood vessels, resulting in tightened blood vessels and increased blood pressure.

Orvaten, or midodrine, is part of the adrenergic and dopaminergic drug class.

Orthostatic hypotension: When blood pressure is low, it is not a good sign and can cause problems. Blood pressure is the force of the blood which pushes against the walls of the arteries. Every time the heart beats, blood is pumped into the arteries. The blood pressure is highest when the heart beats since it pumps blood, however, when one is at rest, blood pressure tends to fall between the beats. This is called diastolic pressure; when the rate is higher, it is called systolic pressure. There are cases when a person always has low blood pressure; in such cases, there are hardly any or at times no symptoms experienced by the person, and readings appear normal. Some people who have low blood pressure experience symptoms of dizziness and fainting when standing up quickly. Low blood pressure becomes a problem only if it causes other issues, such as fainting, tiredness, dizziness, and, in most extreme cases, shock.

Uses of Orvaten:

Orvaten is used for low blood pressure caused by kidney dialysis or by certain medications used to treat mental illness. Orvaten can be given to children with low blood pressure caused by an infection. Since Orvaten is known to cause supine blood pressure, it should be used only in patients whose lives are considerably impaired.

2 What to Know Before Using

Before using Orvaten, you must know all the risks and complications associated with it. As with any other medication, using Orvaten should be a decision you make with your doctor. The risks and benefits the medicine offers must be weighed. Orvaten is not good for everyone. This medicine is only given to patients whose condition does not improve by other treatment options; it should not be taken unless blood pressure is very low and starts affecting daily tasks.

The doctor can conduct a blood test to ensure there are no conditions that could prevent one from using midodrine.  If one is going to have surgery, it is advisable to inform the doctor that you are taking this medication. Apart from consuming the Orvaten drug, one needs to make changes in lifestyle and get special medical care.

For midodrine, you and your doctor must consider the following:

  • Allergies: If you have any reactions to any medicine, be sure to tell your doctor. Additionally, disclose other types of allergies, such as foods, preservatives, animals, or dyes, if any. Read the package ingredients carefully and make sure you are not allergic to any of them.
  • Pediatric: Limited tests have been done with children aged six months to twelve years; Midodrine does not show any different side effects in children.
  • Geriatric: This drug has been tested in the elderly and does not show any side effects different from those listed on its label.
  • Pregnancy: While there are no adequate studies done with pregnant women, animal tests show that midodrine has an adverse effect on the unborn fetus.
  • Breastfeeding: Although there are no adequate studies on lactating mothers that determine potential risk in an infant when breastfeeding, the potential benefits should be weighed against the risks before taking this medication.
  • Drug interactions: Certain medicines have adverse effects when used together. Make sure to inform your doctor about any other drugs you are taking so that alterations and precautions can be made, if necessary.

It is also important to inform your doctor if you are smoking tobacco or drinking alcohol, since these may interact with the drug’s effectiveness.

Your doctor may change your dosage or may not allow you to use this drug if you are taking any of the following:

  • Deslanoside
  • Dihydroergotamine
  • Amitriptyline
  • Dothiepin
  • Clomipramine
  • Amoxapine
  • Phenylephrine
  • Desipramine
  • Nortriptyline
  • Pseudoephedrine
  • Imipramine
  • Digitoxin
  • Doxepin
  • Ephedrine Iobenguane
  • Lofepramine
  • Opipramol
  • Phenylpropanolamine
  • Protriptyline
  • Trimipramine
  • Perphenazine
  • Promethazine
  • Risperidone

Certain medical problems may also alter the effectiveness of midodrine.

If you have other medical conditions, especially heart disease, hypertension, overactive thyroid, visual problems, kidney disease, severe blood pressure, especially while lying down, liver disease, or urinary retention, inform your doctor. This medicine is not administered to patients with excessive supine levels of blood flow resistance.

There are some medicines that tend to interact with Orvaten. In such cases, it is best to inform the doctor of these medications, a few of which are: Prazosin, which is an anti-blocker, and any such anti-blockers can reduce the effectiveness of Orvaten. There are also certain medications that increase the risk of potential side effects, including antiarrhythmics, such as quinidine, procainamide, and flecanide; beta blockers, such as propranolol; and cimetidine, such as dihydroergotamine or triamterene.

3 Proper Usage

To use Orvaten (Midodrine) properly, you must follow all instructions given by your doctor. The last dose of your medicine should not be taken less than three or four hours before bedtime, as Orvaten can cause supine hypertension, resulting in blurred vision, pounding in the ears, and headaches when you lie down after taking it. Do not take Orvaten if you are going to lie down.

Orvaten comes in a tablet form to be taken orally as directed by the physician.


The dosage of midodrine depends on the patient's age, weight, and symptoms, as well as the strength of the medicine. Do not change the dosage the doctor indicated unless you are told otherwise. The number of doses and the number of hours between doses generally depend on the reason you are taking midodrine. One can take Orvaten with or without food. Orvaten should be taken when one is in an upright position or when carrying out certain daily activities which do not involve lying down.

Generally, dosage will be as follows:

For low blood pressure, adults are usually given 10mg three times a day or in four-hour intervals throughout the day. The maximum dose is 40mg daily, but it should be only per prescription. Midodrine should not be consumed after an evening meal or less than four hours before going to bed. Patients who respond well to the initial treatment should continue the use of midodrine.

Doctors typically advise taking the last dose not later than 6 p.m. Dosage will be adjusted as needed.

Missed Dose:

Take a missed dose as soon as possible. If it is almost time for the next dose, skip the missed one and follow your regular dosing schedule. Never take double doses. If you are constantly missing doses, it is best to set an alarm to act as a reminder. You can also consult the doctor for any changes in the dosing schedule or create a new schedule to make up for the skipped dose, if there have been any missed recently.


One should not consume Orvaten more than prescribed. Taking higher doses will not in any way increase the chances of improvement; rather, it can cause side effects which may grow more serious. If one has taken an overdose of Orvaten, immediately consult nearby healthcare for assistance. Do not share your medicines with anyone, even if they have the same condition. Do not prescribe this medicine to them unless they visit the doctor and get themselves checked.

Check the expiration date on the package label before consuming the tablet. A single dose of an expired tablet is not likely to have an adverse impact, however, it is best to check with a doctor if you feel unwell. Expired drugs are usually non-effective when it comes to treating symptoms. To be on the safe side, it is advisable not to ingest expired drugs; especially for people suffering from any chronic illness, such as seizures, heart-related issues, or allergies which are life-threatening, it is best to consult the doctor to keep a fresh supply of medicines.


Keep the medicine in an airtight container at room temperature. Keep it away from direct light, heat, and moisture. Do not let it freeze.

Do not take it out from the blister pack unless it is time to take the medicine. Keep the medication out of children’s reach.

Do not flush the medicine down the toilet or throw it in the drain, as this can lead to environmental contamination. Check with the doctor on how to safely disposed of the medication.

4 Precautions to Take

In using Orvaten (Midodrine), you must be careful and take some precautions as advised by your doctor.

Before taking other medications, first discuss with your doctor, particularly if the medicines tend to increase your blood pressure.

Drugs that tend to do this include medicines for asthma, cough, colds, hay fever, or sinus problems, as well as appetite suppressants.

There is a chance that Orvaten may cause dizziness, fainting, or drowsiness. Hence, one should avoid driving, operating machinery, or carrying out any dangerous activity until you know the reaction to Orvaten. Keep a tab on the blood pressure after taking the medicine or as per the doctor’s directions. During the use of Orvaten, avoid the consumption of any non-prescription medicine that can act as stimulants. A few such products would be suppressants or any cold-related medicine. When it comes to children, be careful with its usage. Check with the doctor before giving this medicine to children.

5 Potential Side Effects

As with many medications, there are several potential side effects associated with Orvaten (Midodrine). Not all people may suffer from these side effects, but if they do, immediate medical attention may be needed.

Contact your doctor as soon as possible if you encounter any of the following:

  • Blurred vision
  • Cardiac awareness
  • Headache
  • Pounding in the ears
  • Fainting
  • Increased dizziness
  • Slow pulse
  • Burning, itching, or prickling of the scalp
  • Chills
  • Goosebumps
  • Urinary frequency, retention, or urgency
  • Anxiety or nervousness
  • Confusion
  • Dry mouth
  • Flushing
  • A headache or feeling of pressure in the head
  • Skin rash
  • Backache
  • Canker sores
  • Drowsiness
  • Dry skin
  • Leg cramps
  • Pain or skin sensitivity
  • Stomach problems such as gas, heartburn, or nausea
  • Trouble seeing
  • Trouble sleeping
  • Weakness

While most of these side effects usually diminish as the body adjusts to the drug, you may need to call your doctor.

Some patients may experience side effects not listed above. If you want to report any side effects, you may do so by calling the FDA at 1-800-FDA-1088.

6 Related Clinical Trials