? When Your Blood Pressure “Drops Like a Rock” During Dialysis…
Sudden drops in blood pressure during dialysis – accompanied by dizziness, nausea, cold sweats, and even having to end the session early – are a nightmare that almost every dialysis patient has experienced.
Today, let’s get to know a little “blood pressure booster powerhouse” that is widely used in dialysis units across Japan – Methylephedrine Tablets.
✨ How does it work?
✨ Who is it suitable for?
✨ How can you use it safely?
This article will explain it all in detail!
01｜Not a Traditional "Pressor", but a “Sympathetic Nervous System Booster”
Mechanism of Action:
Amezinium metilsulfate works by inhibiting the reuptake of norepinephrine at sympathetic nerve endings, indirectly “stimulating” the sympathetic nervous system to rapidly raise blood pressure.
Onset Time:
Approximately 30 minutes after oral intake, with a peak effect at 1–2 hours, covering the dialysis period when blood pressure is most likely to drop.
Metabolism & Excretion:
Metabolized in the liver and excreted via the kidneys. No dose adjustment needed in renal impairment, and dialysis does not significantly clear the drug, resulting in stable blood levels.
02｜Three Major Indications
✔️ Intradialytic Hypotension (IDH)
✔️ Chronic Hypotension Management
✔️ Orthostatic Hypotension
(Detailed clinical use cases can be added here if needed)
03｜How to Store and Dispense 100 Bulk Tablets?
✅ Packaging: 100-tablet bottle without individual blister packs, convenient for portioning as needed.
✅ Storage: Store in a dry, dark place below 25°C. Can be repackaged into weekly pill organizers for portability.
✅ Identification: Each tablet is marked only with “10”. Label clearly to avoid confusion with other medications.
04｜Adverse Effects & Contraindications – The “Three Don’ts”
❌ Do NOT use with MAO inhibitors or tricyclic antidepressants – risk of hypertensive crisis.
❌ Do NOT use in patients with pheochromocytoma or severe coronary artery disease – excessive sympathetic stimulation may induce angina.
❌ Do NOT self-increase dose – doses above 30 mg/day can cause palpitations, headache, anxiety, and other sympathomimetic side effects.
05｜Real Case: Mr. Zhou’s “No More Dialysis Hypotension” Secret
Mr. Zhou, 65 years old, on dialysis for 5 years, used to experience blood pressure drops to 80/50 mmHg within 2 hours of dialysis, often forcing early termination.
After nephrology evaluation, he was prescribed 10 mg amezinium metilsulfate before dialysis. In the first week, his BP stabilized at 110/70 mmHg, with no early termination.
After 4 weeks of monitoring, there was no tachycardia or drug accumulation, and the treatment was continued as part of his long-term plan.
06｜FAQs
? Q1: Can it be taken together with Midodrine?
A: Different mechanisms, theoretically combinable, but blood pressure must be closely monitored under doctor supervision.
? Q2: Can pregnant women take it?
A: No sufficient data; contraindicated in pregnancy.
? Q3: What if I miss a dose?
A: For dialysis use (single-dose), skip if missed before session. For chronic hypotension, take as soon as remembered unless it’s <4 hours to the next dose (in that case, skip). Do not double dose.
Stable blood pressure means a better quality of life.
Amezinium metilsulfate may be the “lifeline” for dialysis hypotension, but it is not a health supplement, nor a substitute for dry weight management, sodium restriction, or dialysis regimen adjustment.
? If you or your family suffer from hypotension, share this article with your doctor to evaluate if this “Japanese ally” is suitable.
Scientific medication is the key to keeping your blood pressure steady and your life on track.