Midodrine=Low Pulse

[Jenn0030]

I increased my midodrine last week and suddenly my HR has dropped to consistently 50 bpm or lower.  Today I spent most of the day in the 40's.  Has anyone had this experience?  I plan on calling the doctor tomorrow, just curious in the meantime.

Jenn

[Jenn0030]

So I talked to the doc office and they were not concerned....as long as my BP is maintaining a normal level.  I will just have to deal with the nausea that the low HR causes and hopefully it will get better soon.  My HR has come up to mostly the low 50's- I have only caught it in the 40's a couple times in the last couple days.  So maybe my body is adapting to the meds.

Jenn

[halbashes]

Though I haven't experienced this reaction myself, I have heard of similar reactions occurring rarely in patients with Neurally Mediated Syncope.

At the very least, it is likely that you will need to adjust your dosage.  So, definitely contact your doctor as soon as you can.  Please let us know how it works out!

[supineallthetime]

"reflex bradycardia" is one possible explanation.  I'm not an expert, but in essence the body might be "compensating" for elevated BP by lowering HR... kind of protecting from too high a BP.

This is like the opposite side of the "classic explanation" for tachycardia during a BP drop... as the BP is falling for some reason, the HR is picked up to try to compensate.  So likewise, if the BP is getting high (but not matching circumstances like exercise) the HR can drop to try to balance it out.

I think clondine or BB's are more directly associated with drops in HR... and midodrine is expected to be a "pressor" and increase both BP and HR (to some extent)... but I think "reflex bradycardia" could explain it.

Definitely, still keep the doctor informed.  It is a tough call on level of concern for bradycardia.  Separate from dysautonomia, the rule of thumb seems to be "bradycardia" is fine if there no other symptoms (especially if it's from good conditioning).  Within dysautonomia, it's possible for bradycardia & tachycardia to co-exist due to general instability... and they kind of tolerate wide swings (appropriate or not).  Keep track of any specific symptom changes that could relate to the bradycardia too, as that will inform the doc as to how to react to it.

[Heiferly]

I have had reactions to medications where my heart rate remains inversely proportional to my blood pressure but flip-flopped so that BP is high and HR is low, but always to medications OTHER than my main dysauto meds (i.e., other than midodrine/fludrocortisone).  Which is to say, normally when supine my BP is at its highest (near normal, on a good day) and my HR is at its lowest (near normal, on a good day); my BP incrementally drops and my HR incrementally increases the closer I get to fully upright.  Therefore, normally, supine is my most comfortable position.  During these reactions, I have HIGH BP and LOW HR when fully upright.  If I recline to fully supine, those follow their normal trend of the BP going even higher and the HR going even lower and I can end up with dangerously low HRs.  I've had to spend entire nights upright to prevent this during such reactions.  

As I said, for me this has only happened in reaction to other medications that I take in addition to my dysauto meds, when adding a med or withdrawing a med has accidentally interfered with my dysauto treatment; so far as I recall it was always with medications that acted on the central nervous system in some manner.  

I've never heard of that as a reaction to midodrine, but that certainly doesn't mean it's not possible.  Did you get through to your doctor?  What did you find out?