{ "schema_version": 1, "kind": "condition", "id": "low-blood-pressure", "name": "Low blood pressure", "category": "acute", "sources": "Bramox (midodrine) 5 mg tablets SmPC sections 4.2-4.4 (eMC product 2268) · Egyptian National Drug Formulary - Endocrine System Drugs 2024, fludrocortisone monograph (endocrine.pdf page index 157, printed p144) · SmPC sections 4.1, 4.2 and 4.4, https://www.medicines.org.uk/emc/product/2268/smpc · Chen RJ, Sharma S, Bhattacharya PT. Hypotension. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Last Update: May 3, 2025. NBK499961.", "review_status": "reviewed", "verified_against": "Egyptian National Drug Formulary - Endocrine System Drugs 2024, fludrocortisone monograph (endocrine.pdf page index 157, printed p144) · SmPC sections 4.1, 4.2 and 4.4, https://www.medicines.org.uk/emc/product/2268/smpc · Chen RJ, Sharma S, Bhattacharya PT. Hypotension. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Last Update: May 3, 2025. NBK499961.", "verified_date": "2026-08", "treatments": [ { "id": 1135, "generic": "Fludrocortisone", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 0.1, "adult_dose": "0.05 mg to 0.2 mg (50-200 micrograms) by mouth once daily, up to a maximum of 0.3 mg daily, titrated to response; reduce to 0.05 mg if hypertension develops. Usually given together with oral hydrocortisone or cortisone. Formulary indications are primary adrenal insufficiency (Addison disease) and classic congenital adrenal hyperplasia.", "adult_duration": "Long-term replacement therapy; the formulary sets no fixed duration and states that dosage depends on disease severity and patient response", "dose_source": "Egyptian National Drug Formulary - Endocrine System Drugs 2024, fludrocortisone monograph (endocrine.pdf page index 157, printed p144)", "rationale": "Standard first-line mineralocorticoid used to expand blood volume and raise pressure in troublesome postural/chronic hypotension once secondary causes are excluded.", "cautions": [ "Do not stop abruptly after long-term use; taper - abrupt withdrawal can cause hypotension, vomiting, fever and myalgia.", "Monitor blood pressure, serum potassium, electrolytes and blood glucose.", "Formulary indications are primary adrenal insufficiency (Addison disease) and classic congenital adrenal hyperplasia only; it is not listed for low blood pressure of other causes.", "Syncope with injury, signs of shock, dehydration, sepsis, gastrointestinal bleeding, suspected adrenal insufficiency.", "Confirm the cause first - dehydration, sepsis, GI bleeding, adrenal insufficiency, and drug causes (antihypertensives, diuretics) must be excluded or corrected before starting a pressor agent.", "Contraindicated in heart failure, significant fluid overload, or uncontrolled severe hypertension.", "Monitor supine and standing blood pressure and serum potassium regularly - risk of hypokalaemia and supine hypertension.", "Causes dose-dependent fluid retention/oedema; use the lowest effective dose, especially in the elderly." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "The formulary says to refer to adult dosing and adjust according to age, weight and severity. No mg/kg figure is given, so no weight-based calculation can be made from this source. Tablets may be crushed and mixed with about a teaspoon of water or soft food. Monitor growth on prolonged therapy.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "ASTONIN-H 0.1MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN > MERCK KGAA F.R.GERMANY", "price_egp": 18.0, "pack_count": 30, "unit_price": 0.6, "strength_mg": 0.1, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CORTILON 0.1 MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN", "price_egp": 16.0, "pack_count": 20, "unit_price": 0.8, "strength_mg": 0.1, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "low-blood-pressure" }, { "id": 1136, "generic": "Midodrine", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 2.5, "adult_dose": "Start 2.5 mg PO TID; titrate weekly based on supine/standing BP to usual maintenance 10 mg TID (take last dose >=4h before bedtime).", "adult_duration": "long-term", "dose_source": "SmPC sections 4.1, 4.2 and 4.4, https://www.medicines.org.uk/emc/product/2268/smpc", "rationale": "Alternative or add-on vasopressor for postural hypotension when lifestyle measures and/or fludrocortisone are insufficient.", "cautions": [ "Try non-drug measures first: 2-2.5 L/day fluid intake, adequate salt, waist-high compression stockings, and stopping any contributing antihypertensive/diuretic.", "Contraindicated in severe organic heart disease, acute renal disease, urinary retention, thyrotoxicosis, and phaeochromocytoma.", "Take the last dose at least 4 hours before bedtime - taken late it causes supine hypertension at night, which is the real harm from this drug." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Safety and efficacy in children have not been established.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "MIDODRINE 2.5MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE.", "price_egp": 50.0, "pack_count": 20, "unit_price": 2.5, "strength_mg": 2.5, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MIDODRINE 1% ORAL DROPS 10ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE.", "price_egp": 67.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "low-blood-pressure" } ] }