In an effort to ameliorate the problem of
orthostatic hypotension in pancreas transplant patients, current medical management consists of maximizing the patient's hydration, altering
antihypertensives, increasing
sodium intake, initiation of
fludrocortisone,
compression stockings, and behavioral modifications. Despite these medical interventions, a subset of patients remains symptomatic.
Midodrine (
ProAmatine), an
alpha-adrenergic agonist, was approved for the treatment of symptomatic
orthostatic hypotension in the US. This preliminary report attempts to assess the safety and efficacy of
midodrine use in kidney/pancreas (KP) or pancreas alone (PA) transplant recipients. A retrospective review was performed of 7 KP and 1 PA recipient experiencing symptomatic
postural hypotension after maximizing other medical treatments. Blood pressure, serum
creatinine (SrCr), and objective responses to
postural hypotension were assessed at routine intervals. Pre-
midodrine monitoring revealed a mean orthostatic change in systolic blood pressure from sitting to standing of 43 mmHg (range 20-100 mmHg). Patients received a mean starting
midodrine dose of 18 mg/d, which was titrated to a maximum dose of 30 mg/d. Systolic blood pressure monitoring revealed a mean orthostatic change of 27 mmHg (range 0-81 mmHg) after initiation of treatment with
midodrine and a mean follow-up of 3.2 months. All study patients reported improvement in symptoms of
orthostatic hypotension. SrCr was not affected based upon comparison of pre-treatment and current SrCr values of 1.4 and 1.3 mg/dL, respectively. The most common side effect experienced was supine
hypertension. These preliminary results suggest that
midodrine is safe and effective in transplant recipients; however, the dosage should be titrated to symptomatic relief or a maximum dose of 30 mg. Careful monitoring for supine
hypertension is necessary.