With about half of votes counted, Mr Medina has 51% of the vote, compared to 47% for former president Hipolito Mejia, electoral officials said.
No major incidents have been reported, despite passions running high over issues such as crime and unemployment.
A run-off will be held next month if no candidate has at least 50% of the vote.
The president of the Electoral Committee, Roberto Rosario, told journalists "the turnout has been high, with an active and peaceful participation from voters".
Voting was delayed in some parts of the country due to heavy rain.
Four other candidates are also running, but opinion polls say they have marginal support and no realistic chance of winning.
Earlier, analysts said the vote was so close that it might be decided by the ballots cast by Dominicans in the United States.
There are more than 300,000 people registered to vote who live abroad, most of them in the New York area.
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