Midodrine for Orthostatic Hypotension: A Systematic Review and Meta-Analysis of Clinical Trials

Abstract

There is insufficient and low quality evidence to support the use of midodrine for OH.

Orthostatic hypotension: pathophysiology, assessment, treatment and the paradox of supine hypertension

“…43 Its short half-life of 2-4 h allows it to be used as a short-term vasopressor when upright during the day, with little worsening of nocturnal hypertension. 44,46 Currently, two trial results are pending regarding these outcomes. It is generally well tolerated, with side effects that include urinary hesitancy, paraesthesia, pruritis and piloerection.…”

Taste and Smell Disturbance Resulting From Midodrine

“…Side effects that differ from those of midodrine are hypokalemia and congestive heart failure. 11 Midodrine was approved in 1996 by the FDA. The medicine was approved based on its ability to increase the 1-minute standing blood pressures in patients with orthostatic hypotension.…”

Midodrine for severe orthostatic hypotension

“…The authors of two systematic reviews assessed the evidence on midodrine in the treatment of orthostatic hypotension 10,11. One review included seven controlled trials in heterogeneous populations (a total of 325 patients with conditions that included chronic tetraplegia, pure autonomic failure, multiple-system atrophy, diabetes and Parkinson's disease) 10.…”

“…One review included seven controlled trials in heterogeneous populations (a total of 325 patients with conditions that included chronic tetraplegia, pure autonomic failure, multiple-system atrophy, diabetes and Parkinson's disease) 10. The effect on blood pressure was reported in three different ways: change in systolic blood pressure from supine to standing (midodrine vs. placebo), change in mean arterial pressure from supine to standing (midodrine vs. placebo) and change in standing systolic blood pressure before and after the intervention.…”