Novel phannaceutcal kit comprising a
controlled release pharmaceutical compositions for oral use containing midodrine and / or its
active metabolite desglymidodrine and a relatively
fast onset composition. The
controlled release compositions are designed to release midodrine and / or desglymidodrine after oral intake in a manner which enables absorption to take place in the
gastrointestinal tract so that a relatively fast
peak plasma concentration of the
active metabolite desglymidodrine is obtained followed by a prolonged and relatively constant
plasma concentration of desglymidodrine. The
controlled release compositions may be designed for administration once or twice daily, i.e. a therapeutically effective concentration of desglymidodrine is maintained for a period of at least 10-16 hours followed by a wash out period of about 8-12 hours in order to avoid the well-known midodrine related
side effect with respect to supine hypertension. The therapeutically effective concentration of desglymidodrine is regarded as a
plasma concentration of desglymidodrine of at least about 3 ng / ml. A composition is designed to release midodrine and / or desglymidodrine in at least the following consecutive steps; i) an initial relatively
fast release of midodrine and / or desglymidodrine (in order to obtain a relatively
fast onset of action), ii) a steady release or a slower release than in step 1 of midodrine and / or desglymidodrine (in order to maintain a
plasma concentration of desglymidodrine which is prolonged and relatively constant), iii) a second rise in release of midodrine and / or desglymidodrine (in order to take
advantage of absorption from the colon, i.e. such a second rise release is designed to take place when the composition (or the disintegrated parts of the composition) reaches the colon; normally this is regarded to take about 8 hours after oral intake, and iv) a decline in release rate corresponding to that essentially all midodrine and / or desgtymidodrine have been released from the composition. One of the advantages of the invention is that the controlled release composition provides a
base line plasma concentration, which during most of the day is therapeutically effective. When a higher concentration is needed, only a minor supply of active
drug substance is necessary to obtain a very fast relief from symptoms. If the constant
base line plasma concentration was absent, it would be necessary to use a relative higher
fast onset dose to reach the high therapeutically effective level. The kit according to the present invention is a superior tool for obtaining an
optimal treatment with a minimum of active
drug substance. Also disclosed is a method for treating orthostaic hypotension and / or
urinary incontinence, the method comprising administration to a patient in need thereof of an effective amount of midodrine and / or desglymidodrine in a kit according to the invention.