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Drug Safety-related Labeling Changes (SrLC)

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PROAMATINE (NDA-019815)

(MIDODRINE HYDROCHLORIDE)

Safety-related Labeling Changes Approved by FDA Center for Drug Evaluation and Research (CDER)

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02/07/2017 (SUPPL-10)

Approved Drug Label (PDF)

5 Warnings and Precautions

PRECAUTIONS/Drug Interactions

(subsection revised, additions underlined)

The risk of hypertension increases with concomitant administration of drugs that increase blood pressure (phenylephrine, pseudoephedrine, ephedrine, dihydroergotamine, thyroid hormones, or droxidopa). Avoid concomitant use of drugs that increase blood pressure. If concomitant use cannot be avoided, monitor blood pressure closely.

Avoid use of MAO inhibitors or linezolid with midodrine.

WARNINGS

(additions underlined)

Supine Hypertension: The most potentially serious adverse reaction associated with ProAmatine® therapy is marked elevation of supine arterial blood pressure (supine hypertension). Systolic pressure of about 200 mmHg were seen overall in about 13.4% of patients given 10 mg of ProAmatine®. Systolic elevations of this degree were most likely to be observed in patients with relatively elevated pre-treatment systolic blood pressures (mean 170 mmHg). There is no experience in patients with initial supine systolic pressure above 180 mmHg, as those patients were excluded from the clinical trials. Use of ProAmatine® in such patients is not recommended. Sitting blood pressures were also elevated by ProAmatine® therapy. It is essential to monitor supine and sitting blood pressures in patients maintained on ProAmatine®. Uncontrolled hypertension increases the risk of cardiovascular events, particularly stroke.