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


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.


CONCLUSIONS
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.
Perez-Lugones
A
A
The Cleveland Clinic Foundation, Ohio 44195, USA.
Schweikert
R
R
Pavia
S
S
Sra
J
J
Akhtar
M
M
Jaeger
F
F
Tomassoni
G F
GF
Saliba
W
W
Leonelli
F M
FM
Bash
D
D
Beheiry
S
S
Shewchik
J
J
Tchou
P J
PJ
Natale
A
A
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use*; D000328:Adult; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007629:Kentucky; D008297:Male; D008875:Middle Aged; D008879:Midodrine / Q000627:therapeutic use*; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D012008:Recurrence; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D019462:Syncope, Vasovagal / Q000188:drug therapy*; D016896:Treatment Outcome; D014922:Wisconsin
D000316:Adrenergic alpha-Agonists; D008879:Midodrine