title: Refractory hypotension due to Rogaine® (minoxidil) ingestion managed with midodrine.
abstract: BACKGROUND
  Minoxidil (Rogaine®) is a direct vasodilator that can cause significant toxicity when ingested. We report a case of ingestion of topical minoxidil [Rogaine® (Johnson & Johnson Healthcare Products, Division of McNeil-PPC, Inc)] resulting in refractory hypotension that was successfully managed with the oral α (1) agonist midodrine.
  
  
  METHODS
  A 48-year-old male who ingested an eight ounce bottle of Rogaine® presented to the emergency department. The patient presented with a blood pressure of 57/45 mmHg and a pulse of 84 beats per minute. The patient received IV fluids and multiple vasopressors to maintain an adequate mean arterial pressure. Midodrine, an oral α (1) vasopressor, was added 10 hours post ingestion and was able to maintain an adequate mean arterial pressure. Over the next two days, midodrine was titrated down as his blood pressure returned to baseline.
  
  
  CONCLUSIONS
  Midodrine may serve as an additional option to treat toxicant induced hypotension.
authors.affiliation: Upstate NY Poison Center, Emergency Medicine, Syracuse, USA. GARRARDA@upstate.edu
authors.forename: Alexander
authors.initials: A
authors.lastname: Garrard
authors.forename: Adam
authors.initials: A
authors.lastname: Wood
authors.forename: Dawn
authors.initials: D
authors.lastname: Sollee
authors.forename: Patrick
authors.initials: P
authors.lastname: Aaronson
mesh_terms: D000284:Administration, Oral; D058646:Adrenergic alpha-1 Receptor Agonists / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D004636:Emergency Service, Hospital; D006801:Humans; D007022:Hypotension / Q000139:chemically induced / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D008879:Midodrine / Q000627:therapeutic use*; D008914:Minoxidil / Q000008:administration & dosage / Q000506:poisoning*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000506:poisoning*
chemical_list: D058646:Adrenergic alpha-1 Receptor Agonists; D014665:Vasodilator Agents; D008914:Minoxidil; D008879:Midodrine