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More commonly used than droxidopa: Midodrine was approved in the 1990s (droxidopa was approved in 2014) Most clinicians have longer experience with midodrine Midodrine is available as a generic & is less expensive Droxidopa is typically reserved for use as an add-on when midodrine is ineffective, or midodrine is not tolerated due to side effects Contraindications: hypertension heart failure acute kidney failure urinary retention thyrotoxicosis pheochromocytoma Side Effects: Supine hypertension WARNING : may cause marked hypertension when the patient is supine (laying down)