Letter to the Editor: “Midodrine to liberate ICU patients from intravenous vasopressors: Another negative fixed-dose trial”

Riker, Richard R.; Gagnon, David J.

doi:10.1016/j.jcrc.2022.153995

Cited by 2 publications

(1 citation statement)

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“…One limitation of all RCT evidence thus far for midodrine as a vasopressor weaning agent is protocolised fixed drug dosing. 114 Published RCTs have all either utilised 10 mg or 20 mg midodrine at 8-hourly dose intervals. This differs to normal clinical practice where vasopressor support is usually titrated to a mean arterial pressure (MAP) target in real time.…”

Section: Further Considerations In the Critically Ill Patientmentioning

confidence: 99%

Midodrine use in critically ill patients: a narrative review

Costa-Pinto¹,

Jones²,

Udy³

et al. 2022

Critical Care and Resuscitation

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Midodrine is a peripherally acting, oral α-agonist that is increasingly used in intensive care units despite conflicting evidence for its effectiveness. It has pharmacological effects on blood vessels as well as pupillary, cardiac, renal, gastrointestinal, genitourinary, lymphatic and skin tissue. It has approval for use as a treatment for orthostatic hypotension, but a surge in interest over the past decade has prompted its use for a growing number of off-label indications. In critically ill patients, midodrine has been used as either an adjunctive oral therapy to wean vasoplegic patients off low dose intravenous vasopressor infusions, or as an oral vasopressor agent to prevent or minimise the need for intravenous infusion. Clinical trials have mostly focused on midodrine as an intravenous vasopressor weaning agent. Early retrospective studies supported its use for this indication, but more recent randomised controlled trials have largely refuted this practice. Key questions remain on its role in managing critically ill patients before intensive care admission, during intensive care stay, and following discharge. This narrative review presents a comprehensive overview of midodrine use for the critical care physician and highlights why lingering questions around ideal patient selection, dosing, timing of initiation, and efficacy of midodrine for critically ill patients remain unanswered.

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Section: Further Considerations In the Critically Ill Patientmentioning

confidence: 99%