Midodrine hydrochloride in the treatment of vasovagal syncope.
Therapy of vasovagal syncope is still a subject of debate. Various pharmacotherapies were proposed. However, they are often not tolerated or ineffective. The purpose of this prospective, nonrandomized study was to evaluate the usefulness of alpha-agonist midodrine hydrochloride in the treatment of vasovagal syncope. Forty-one patients (mean age 34 years, 18 men) with history of recurrent syncope and positivity of head-up tilt testing were included (28 patients with type 1, 10 patients with type 2, 3 patients with type 3 according to VASIS classification). In all patients oral therapy with midodrine was started. Initial dose was 2.5 mg two times daily. When necessary, the dose was increased to 5 mg two times daily. Efficacy of treatment was assessed by repeated head-up tilt testing after 1-2 weeks of therapy and by long-term follow-up. After midodrine hydrochloride treatment, 39 of 41 patients (95%) had no inducible presyncope or syncope on repeated tilt table testing. Effective dose was 2.5 mg two times daily in 25 patients and 5 mg two times daily in 16 patients. During a mean follow-up period 19+/-9 months, 38 of 39 patients (97%) with negative repeated tilt table test remained free of syncope recurrence.
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Department of Internal Medicine II, Medical Faculty, University of P.J. Safarik, Kosice, Slovakia. pmitro@kosice.upjs.sk
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D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008879:Midodrine / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D012008:Recurrence; D019462:Syncope, Vasovagal / Q000188:drug therapy*; D018667:Tilt-Table Test; D016896:Treatment Outcome
D000316:Adrenergic alpha-Agonists; D008879:Midodrine