Midodrine (Proamatine, Amatine)

Midodrine is used to treat orthostatic intolerance in chronic fatigue syndrome

Midodrine (ProAmatine) is…

an ‘alpha-1 agonist’ drug that tightens blood vessels (increases ‘vascular tone’) and increases blood pressure by mimicking the actions of norepinephrine. Because Midodrine can cause increased blood pressure when lying down Midodrine is typically prescribed when other non-pharmacologic approaches (support stockings, increased fluid/salt intake,etc.) fail (Chronically increased blood pressure can have serious long term effects – but see below). Patients on Midodrine often take Florinef as well.

Midodrine May Work in Chronic Fatigue Syndrome (ME/CFS) Because…

it tightens blood vessels, reducing blood pooling and increasing blood flows to the heart and low blood pressure in patients with low blood pressure.

Chronic Fatigue Syndrome (ME/CFS) Studies…

A pilot study suggested Midodrine improved autonomic functioning and fatigue in ME/CFS patients. One paper recited the return to health of one CFS patient taking Midodrine. A larger study was reported under way several years ago but has not been published.

Chronic Fatigue Syndrome (ME/CFS) Doctors Report…

Dr Chia and Dr. Klimas reports success using this drug in some patients. At the 2008 IACFS/ME conference Dr. Bell stated he’d used Midodrine effectively in many patients. See Dr. Rowe’s report.


Doses start out low (2.5 mg) and build up (2.5-10 mg three times a day). Dr. Klimas suggests taking Midodrine before meals.

Side Effects (not complete)

The drug appears to be generally well tolerated. Dr. Rowe reports that ME/CFS patients with orthostatic hypotension (low blood pressure on standing) can experience high blood pressure when lying down, itching, pins and needles sensations and urinary urgency. Regular blood pressure monitoring is indicated.

Since Midodrine reaches its maximum effectiveness approximately 1-2 hours after taking it increases in blood pressure during sleep can be ameliorated by taking Midodrine at least 4 hours before going to bed. Cold remedies that can increase blood pressure should be used with caution.

(This and all sections of the Phoenix Rising website are compiled by a layman with ME/CFS. They are not a substitute for a physician and are for informational uses only. Please discuss any treatments in these pages with your physician.)


Klimas, Nancy. Dr. Nancy Klimas LectureJune 27, 1999 by Ken Casanova

Medscape. Midodrine in Patients with Orthostatic Intolerance.

J Naschitz, D Dreyfuss, D Yeshurun and I Rosner. Midodrine treatment for chronic fatigue syndrome. Postgrad. Med. J. 2004;80;230-232

Naschitz. Dysautonomia in chronic fatigue syndrome: facts, hypotheses, implications . J Medical Hypotheses , Volume 62 , Issue 2 , Pages 203 – 206.

Rowe, Peter. 2003. Pediatric Network

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