Efficacy and safety of midodrine hydrochloride in patients with refractory vasovagal syncope

Therapy for Syncope

“…[36][37][38] Two controlled studies, one in an adult population 39 and the other in a pediatric population, 40 showed that midodrine used as a first-line therapy was effective in reducing syncope recurrences. However, most recently, Romme and colleagues 41 performed a randomized crossover study, in which they compared midodrine versus placebo in patients in whom nonpharmacologic therapy failed to prevent syncope recurrences; midodrine was not superior to placebo in preventing syncope recurrences in this population.…”

Management of syncope in pediatric patients

“…Main side effects Piloerection (13%), pruritus (12%), urinary urgency, retention, or polyuria, dysuria (up to 13%), paresthesia (18.3%). Special points Randomized studies on short-term outcomes in adults with vasovagal syncope have shown a beneficial effect [22][23][24]. However, there are no clinical trials with ␣ agonists in the pediatric population and we tend to reserve its use for those patients who have failed other therapies.…”

Der Patient mit Synkope

“…Dies beruht auf dem Fehlen randomisierter Studien oder der widersprüchlichen Datenlage [2]. Als effektiv können sich individuell jedoch der α-AdrenozeptorAgonist Midodrin [2,12,21,23], β-Rezeptoren-Blocker [2,6,7,9,16,17,25,31], der SerotoninWiederaufnahmehemmer Fluoxetin [2,8] sowie das Mineralokortikoid Fludrocortison [2] erweisen. Midodrin war in einer Dosierung von 2 × 2,5-5 mg/d in zwei Studien [12,21] sowohl kurz-als auch langfristig effektiv.…”