Limited Use Note(s) |
|
MIDODRINE HCL5mg Tab
| Reason For Use Code | Clinical Criteria |
|---|---|
| 1 | For the treatment of patients disabled by moderate to severe neurogenic orthostatic hypotension (i.e. drop in systolic BP less than or equal to 20mm Hg from supine to standing position), in whom conventional nonpharmacologic and pharmacologic (i.e. fludrocortisone) therapies have proven ineffective or are poorly tolerated. |
| LU Authorization Period: Indefinite |