I Am using since a week midodrine tablets and not the cream!
Is anyone familiar with this as a tablet?
I have tried oral midodrine and it made everything so much more painful. I know this post is oldish, but was searching for any info on oral midodrine and was surprised this is the only one I could find.
Luckily the half-life of midodrine is pretty short so the effect was gone after a few hours.
It felt like all my muscles or blood vessels in my face+hands were clenching + being squeezed by snakes. best I can describe it lol.
curious about other experiences with (oral) midodrine.
I asked my doctor about topical midodrine in 2015. His answer should be applicable to oral administration, as well. Here was part of his response:
Midodrine is an alpha 1 agonist and is a vasoconstrictor; typically in all pain studies, when vasoconstrictors are applied locally then this intensifies pain…
There is no pain condition that we ever treat by giving a vasoconstrictor, and the mechanism of erythromelalgia typically involves sodium channel defects.
Suffice to say, he would not prescribe midodrine for erythromelalgia. He practices as an anesthesiologist and pain specialist.
Thanks for sharing his response. That seems consistent with what I experienced, then.
I’m curious though - many take beta blockers for EM (and recall you find propranolol helpful?) Aren’t beta blockers essentially peripheral constrictors?
In any case it definitely seems like it would be worthwhile for me to find a pain specialist (in addition to my dermatologist).
Since β2 adrenergic receptors can cause vascular smooth muscle dilation, beta blockers may cause some vasoconstriction. However, this effect tends to be small because the activity of β2 receptors is overshadowed by the more dominant vasoconstricting α1 receptors.
Propranolol is a β2 blocker, while midodrine is an α1 agonist.
EDIT: I was originally prescribed propranolol as a teen for a begnin neurological condition, essential tremor. It’s possible the modest symptomatic relief for EM I receive from propranolol is related to my unique physiology as someone who also has essential tremor. It is the reason propranolol was the first medication I tried for my EM symptoms. I already had it in my closet.
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