title: Midodrine and clonidine in patients with cirrhosis and refractory or recurrent ascites: a randomized pilot study.
abstract: OBJECTIVE
  Splanchnic arterial vasodilatation and subsequent activation of anti-natriuretic and vasoconstrictive mechanisms have an important role in cirrhotic ascites. The aim of this study was to evaluate the effects of midodrine, clonidine, and their combination on systemic hemodynamics, renal function, and control of ascites in patients with cirrhosis and refractory or recurrent ascites.
  
  
  METHODS
  Sixty cirrhotic patients with refractory or recurrent ascites were prospectively studied after long-term administration of clonidine (n=15) or midodrine (n=15), or both (n=15) plus standard medical therapy (SMT), or SMT alone (n=15), in a randomized controlled trial at a tertiary center.
  
  
  RESULTS
  A significant increase in urinary volume, urinary sodium excretion, mean arterial pressure, and decrease in plasma renin activity (P<0.05) was noted after 1 month. There was also a significant decrease in cardiac output (P<0.05) and increase in systemic vascular resistance (P<0.05) in all groups, except clonidine. There was no change in glomerular filtration rate and model for end-stage liver disease score. Midodrine and a combination of midodrine and clonidine plus SMT were superior to SMT alone in the control of ascites (P=0.05), and there was a trend towards better control of ascites in the clonidine group (P=0.1). The mortality and frequency of various complications were similar in all groups.
  
  
  CONCLUSIONS
  These results suggest that midodrine, clonidine, and their combination plus SMT improves the systemic hemodynamics without any renal or hepatic dysfunction, and is superior to SMT alone for the control of ascites. However, the combination therapy was not superior to midodrine or clonidine alone.
authors: Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. virendrasingh100@hotmail.com
authors: Virendra
authors: V
authors: Singh
authors: Ajay
authors: A
authors: Singh
authors: Baljinder
authors: B
authors: Singh
authors: Rajesh
authors: R
authors: Vijayvergiya
authors: Navneet
authors: N
authors: Sharma
authors: Anchal
authors: A
authors: Ghai
authors: Ashish
authors: A
authors: Bhalla
mesh_terms: D058646:Adrenergic alpha-1 Receptor Agonists / Q000627:therapeutic use*; D058647:Adrenergic alpha-2 Receptor Agonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D001201:Ascites / Q000188:drug therapy*; D003000:Clonidine / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D008879:Midodrine / Q000627:therapeutic use*; D010865:Pilot Projects; D011446:Prospective Studies; D055502:Secondary Prevention; D016896:Treatment Outcome
chemical_list: D058646:Adrenergic alpha-1 Receptor Agonists; D058647:Adrenergic alpha-2 Receptor Agonists; D008879:Midodrine; D003000:Clonidine