Taste and smell disturbance with the alpha-adrenoceptor agonist midodrine.
OBJECTIVE
To report a case of a disturbance of taste and smell associated with the alpha-adrenoceptor agonist midodrine.


METHODS
A 64-year-old white man with autonomic failure was started on midodrine 5 mg/day as treatment for orthostatic hypotension. After 3 months, the dose was increased to 12.5 mg/day, whereupon he noted a new onset of taste and smell disturbance. These symptoms made eating so unpleasant that the man greatly reduced his food intake, leading to significant weight loss. In addition, he experienced well-recognized adverse effects of midodrine, such as scalp pruritus, after the dose increase. All symptoms resolved with a dose reduction of midodrine (to 5 mg/day), and the patient increased his food intake, resulting in a return to his initial body weight.


CONCLUSIONS
Midodrine is commonly associated with dose-dependent adverse effects, such as scalp pruritus and cutis anserina. Disorders of taste and smell have not been previously reported with midodrine, although it has been suggested that other sympathomimetic drugs may have effects on the olfactory threshold. Severe disorders of taste and smell may impact not only on a patient's quality of life, but also on their physical well-being, with significant weight loss being reported in this case. According to the Naranjo probability scale, this patient's taste and smell disturbance was probably associated with midodrine.


CONCLUSIONS
The use of midodrine may be associated with taste and smell disturbance. This case suggests that such an association is likely to be dose dependent.
Neurovascular Medicine Unit, Imperial College London, St. Mary's Hospital, London, England. dtimyoung@hotmail.com
Tim M
TM
Young
Christopher J
CJ
Mathias
D000317:Adrenergic alpha-Antagonists / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008879:Midodrine / Q000009:adverse effects*; D000857:Olfaction Disorders / Q000139:chemically induced*; D013651:Taste Disorders / Q000139:chemically induced*
D000317:Adrenergic alpha-Antagonists; D008879:Midodrine