title: Midodrine for the weaning of vasopressor infusions.
abstract: OBJECTIVE
  Midodrine, an orally available α1-agonist indicated for the treatment of orthostatic hypotension, has been used at our institution as an adjunctive treatment to provide haemodynamic support to facilitate intravenous (IV) vasopressor weaning. Limited published data exist for this off-label use; thus, the objective of this study was to evaluate outcomes in patients who received midodrine for IV vasopressor weaning compared to control patients.
  
  
  METHODS
  This retrospective comparison included adult ICU patients admitted to our institution from January 2007 to March 2012. The primary outcome was the time to IV vasopressor discontinuation after midodrine initiation. Secondary outcomes included a comparison between midodrine and control patients of the time from IV vasopressor discontinuation to ICU discharge, hospital and ICU length of stay (LOS), and the number of ICU readmissions.
  
  
  CONCLUSIONS
  The analysis included 188 patients (94 midodrine and 94 control). Patients discontinued IV vasopressors a median of 1·2 days (IQR 0·5-2·8) after midodrine initiation. ICU discharge occurred sooner after IV vasopressor discontinuation (0·8 vs. 1·5 days, P = 0·01), and 96% of patients remained off IV vasopressors after midodrine treatment. Hospital LOS was longer in midodrine patients (P < 0·01), but there were no differences in ICU LOS or readmissions. Adverse event rates after midodrine use were consistent with those observed in other studies.
  
  
  CONCLUSIONS
  Midodrine may serve as a useful adjunct to wean IV vasopressors in difficult-to-wean patients. Further studies are needed to assess the efficacy and safety of midodrine for this indication.
authors.affiliation: Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
authors.forename: L B
authors.initials: LB
authors.lastname: Poveromo
authors.affiliation: Department of Pharmacy, Mission Health System, Eshelman School of Pharmacy, University of North Carolina, Asheville, NC, USA.
authors.forename: E L
authors.initials: EL
authors.lastname: Michalets
authors.affiliation: Greenville Health System Care Coordination Institute, Greenville, SC, USA.
authors.forename: S E
authors.initials: SE
authors.lastname: Sutherland
mesh_terms: D058646:Adrenergic alpha-1 Receptor Agonists / Q000008:administration & dosage*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006760:Hospitalization; D006801:Humans; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008879:Midodrine / Q000008:administration & dosage*; D056687:Off-Label Use; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
chemical_list: D058646:Adrenergic alpha-1 Receptor Agonists; D014662:Vasoconstrictor Agents; D008879:Midodrine
keywords: hypotension; intensive care unit; intravenous vasopressors; midodrine; shock