Usefulness of midodrine in patients with severely symptomatic neurocardiogenic syncope: a randomized control study.

Abstract

INTRODUCTION:

The efficacy of midodrine for the management of patients with neurocardiogenic syncope was assessed prospectively in a randomized control study.

METHODS AND RESULTS:

Patients who had at least monthly occurrences of syncope and a positive tilt-table test were included in the study. A total of 61 patients were randomly allocated to treatment either with midodrine or with fluid, salt tablets, and counseling. Midodrine was given at a starting dose of 5 mg three times a day and increased up to a dose of 15 mg three times a day when required. Midodrine was given during the daytime every 6 hours. Thirty-one patients were assigned to treatment with midodrine; the other 30 patients were advised to increase their fluid intake and were instructed to recognize their prodromes and abort the progression to syncope. Patients were followed-up for at least 6 months. A quality-of-life questionnaire was administered at the time of randomization and 6 months after. At the 6-month follow-up, 25 (81%) of 31 midodrine-treated patients and 4 (13%) of the 30 fluid-therapy patients had remained asymptomatic (P < 0.001). One patient had to discontinue taking midodrine due to severe side effects and another six patients experienced minor side effects that did not require drug discontinuation.

CONCLUSION:

Midodrine appeared to provide a significant benefit in patients with neurocardiogenic syncope. To prevent recurrence of symptoms, dose adjustments were required in about one third of patients.

• Authors: A Perez-Lugones, R Schweikert, S Pavia, J Sra, M Akhtar, F Jaeger, G F Tomassoni, W Saliba, F M Leonelli, D Bash, S Beheiry, J Shewchik, P J Tchou, A Natale
• Journal: Journal of cardiovascular electrophysiology (J Cardiovasc Electrophysiol) Vol. 12 Issue 8 Pg. 935-8 (Aug 2001) ISSN: 1045-3873 [Print] United States
• PMID: 11513446 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Adrenergic alpha-Agonists
• Midodrine

Topics

• Adrenergic alpha-Agonists (therapeutic use)
• Adult
• Dose-Response Relationship, Drug
• Female
• Follow-Up Studies
• Humans
• Kentucky
• Male
• Middle Aged
• Midodrine (therapeutic use)
• Prospective Studies
• Quality of Life (psychology)
• Recurrence
• Severity of Illness Index
• Surveys and Questionnaires
• Syncope, Vasovagal (drug therapy)
• Treatment Outcome
• Wisconsin