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At least 73 records · Page 4Linked to original sources
PubMed2004

Midodrine prescribed to improve recurrent post-spaceflight orthostatic hypotension.

Many astronauts exhibit post-spaceflight orthostatic hypotension due to inadequate norepinephrine release when in an upright posture. We hypothesized that an alpha1-adrenergic agonist, midodrine, would be an effective countermeasure. A female astronaut, who had problems with postflight orthostatic hypotension after a previous flight, consumed 10 mg midodrine after a subsequent flight, prior to her tilt test. Hemodynamic variables were compared between the two flights. Midodrine prevented severe falls in stroke volume, cardiac output and systolic pressure, and severe increases in heart rate without increasing vascular resistance, thus preventing orthostatic hypotension. This is the first report showing that midodrine has the potential to improve post-spaceflight orthostatic hypotension and suggesting that reduced venous return contributes to the etiology.

Adrenergic alpha-Agonists↗
PubMed1996

Midodrine efficacy and pharmacokinetics in a patient with recurrent intradialytic hypotension.

Recurrent intradialytic hypotension, a complication of hemodialysis, is a consequence of an inadequate compensatory response or a paradoxic response to ultrafiltration-induced volume reduction. We report the use of midodrine, an alpha agonist, in an 18-year-old man with Bardet-Biedl syndrome and recurrent intradialytic hypotension. The clinical features of the intradialytic hypotensive spells are consistent with a paradoxic withdrawal of sympathetic activity, although an underlying abnormality in autonomic dysfunction cannot be excluded. Midodrine significantly increased the intradialytic blood pressure and decreased the intradialytic hypotensive episodes requiring intervention. The pharmacokinetic characteristics of the prodrug midodrine and the active metabolite de-glymidodrine in this patient with end-stage renal disease approximate those reported for patients with normal renal function. However, the prolonged terminal half-life for the active metabolite, de-glymidodrine, warrants careful administration in patients with renal failure.

Adolescent↗
PubMed1999

Preliminary observations on the use of midodrine hydrochloride in the treatment of refractory neurocardiogenic syncope.

Recurrent episodes of neurocardiogenic syncope that occur without warning are a common cause of recurrent syncope that can be identified during head upright tilt table testing. While the use of beta blockers, theophyllines, fludrocortisone, disopyramide, and serotonin reuptake inhibitors can be useful in the prevention of episodes, some patients are either unresponsive to or poorly tolerant of these agents. We investigated the use of the peripheral alpha stimulating agent midodrine in preventing both tilt-induced and spontaneous neurocardiogenic syncope. Twenty-five patients (16 women, 9 men, mean age 30 +/- 23 years) with severe recurrent syncope and a positive head upright tilt table study (refractory to or intolerant of standard therapies) were placed on midodrine 5-10 mg orally three times per day, (two patients required 15 mg/day). Of these, twelve became asymptomatic and five had a marked reduction in symptoms. We conclude that midodrine may be an effective therapy in patients with recurrent neurocardiogenic syncope refractory to other forms of therapy.

Administration, Oral↗
PubMed2000

Midodrine hydrochloride and the treatment of orthostatic hypotension in tetraplegia: two cases and a review of the literature.

STUDY DESIGN: A report of two cases of orthostatic hypotension in acute tetraplegia that were resistant to classic treatment interventions. OBJECTIVE: To discuss the use of midodrine hydrochloride for the treatment of orthostatic hypotension in early tetraplegia. SETTING: Department of Rehabilitation Medicine, The University of Texas Health Science Center at San Antonio, Texas, USA. METHODS: Presentation of two cases. RESULTS: Midodrine hydrochloride successfully treated two cases of orthostatic hypotension that had been refractory to classic treatment interventions. CONCLUSION: Midodrine hydrochloride should be included in the armamentarium of the physician treating orthostatic hypotension in spinal cord injury.

Adrenergic alpha-Agonists↗
PubMed2001

Treatment of Severe Intradialytic Hypotension With the Addition of High Dialysate Calcium Concentration to Midodrine and/or Cool Dialysate.

Treatment of intradialytic hypotension (IDH) in the end-stage renal disease population has been a difficult task for nephrologists caring for these patients. The presence of multiple pathogenic factors contributes to hemodynamic instability and explains why therapies that modulate only a specific aspect of the problem are only partially effective. Cool dialysate (34.5 degrees C to 35.5 degrees C) and midodrine may provide hemodynamic stability through an increase in peripheral vascular resistance, whereas high dialysate calcium concentration (HDCa; 3.5 mEq/L) improves intradialytic blood pressure through preservation of cardiac output. Theoretically, the combination of these two types of therapies might further reduce the frequency and severity of hypotension during hemodialysis (HD). We undertook a study to evaluate the effect of HDCa added to midodrine and/or cool dialysate in the treatment of patients with severe IDH. Twenty-eight patients met the entry criteria, and 23 patients completed the prospective crossover study. Five patients dropped out of the study secondary to hypercalcemia. The addition of HDCa significantly improved post-HD mean arterial pressure (MAP; 95.6 +/- 12.7 versus 90.8 +/- 12.5 mm Hg; P = 0.002). The decreases in MAP from pre-HD to lowest intradialytic (16.3 +/- 8.2 versus 20.6 +/- 10.0 mm Hg; P = 0.009) and pre-HD to post-HD (2.0 +/- 8.5 versus 8.15 +/- 10.8 mm Hg; P = 0.002) were significantly reduced with HDCa compared with low dialysate calcium. However, there were no significant improvements in symptoms of or interventions for IDH. Thus, it appears that the addition of HDCa to midodrine and/or cool dialysate further improves blood pressure in patients with IDH. However, this therapy did not reduce symptoms or interventions required for IDH. In addition, hypercalcemia complicated this therapy in 22% of the patients.

Blood Pressure↗
PubMed2001

Midodrine for the management of orthostatic hypotension in patients with spinal cord injury: A case report.

A 21-year-old man sustained anterior displacement and a burst fracture of C7 in a motor vehicle crash. He underwent anterior corpectomy, decompression, fusion of C6-T1 vertebrae, and halo placement. The American Spinal Injury Association grade of his spinal cord injury (SCI) was C6 C tetraplegia. Severe orthostatic hypotension in the upright position complicated the patient's rehabilitation program. Midodrine was prescribed, and other medications with possible adverse effects were adjusted. Significant improvement after taking midodrine was reflected in the orthostatic vital signs and symptoms, as well as in FIM instrument scores. Staff noted improvements with therapy participation and functional status. The patient tolerated the midodrine well and had no significant side effects.

Adult↗
PubMedDate not supplied

The alpha-sympathomimetic midodrin as a tool for diagnosis and treatment of sperm transport disturbances.

The present study was performed to determine the usefulness of the alpha-sympathomimetic midodrin for diagnosis and treatment of functional sperm transport disturbances. 140 andrological patients consulting due to severe oligozoospermia, hypospermia or partial/complete retrograde ejaculation were included. Ejaculates were examined 30 min after intravenous injection of 5-15 mg midodrin. Sperm concentration, motility and alpha-glucosidase as a marker of both epididymal function and sufficient passage through the vasa deferentia and the ejaculatory duct were measured and the values compared to those in the ejaculates obtained before therapy. In 23 of 140 patients, sperm concentration or total sperm count was improved by more than 10 million spermatozoa ml-1 or 20 million spermatozoa per ejaculation. Alpha-glucosidase in the seminal plasma increased in two cases. The present study demonstrates that severe oligozoospermia may be caused by functional transport disturbance of semen from the epididymis to the efferent duct system. In these cases, midodrin is of diagnostic and therapeutic value; however, it should be emphasized that its effectiveness cannot be predicted individually.

Ejaculation↗
PubMed1999

Midodrine hydrochloride in the treatment of vasovagal syncope.

Therapy of vasovagal syncope is still a subject of debate. Various pharmacotherapies were proposed. However, they are often not tolerated or ineffective. The purpose of this prospective, nonrandomized study was to evaluate the usefulness of alpha-agonist midodrine hydrochloride in the treatment of vasovagal syncope. Forty-one patients (mean age 34 years, 18 men) with history of recurrent syncope and positivity of head-up tilt testing were included (28 patients with type 1, 10 patients with type 2, 3 patients with type 3 according to VASIS classification). In all patients oral therapy with midodrine was started. Initial dose was 2.5 mg two times daily. When necessary, the dose was increased to 5 mg two times daily. Efficacy of treatment was assessed by repeated head-up tilt testing after 1-2 weeks of therapy and by long-term follow-up. After midodrine hydrochloride treatment, 39 of 41 patients (95%) had no inducible presyncope or syncope on repeated tilt table testing. Effective dose was 2.5 mg two times daily in 25 patients and 5 mg two times daily in 16 patients. During a mean follow-up period 19+/-9 months, 38 of 39 patients (97%) with negative repeated tilt table test remained free of syncope recurrence.

Adrenergic alpha-Agonists↗
PubMed2001

Midodrine prevents orthostatic intolerance associated with simulated spaceflight.

Many astronauts after being weightless in space become hypotensive and presyncopal when they assume an upright position. This phenomenon, known as orthostatic intolerance, may interfere with astronaut function during reentry and after spaceflight and may limit the ability of an astronaut to exit a landed spacecraft unaided during an emergency. Orthostatic intolerance is more pronounced after long-term spaceflight and is a major concern with respect to the extended flights expected aboard the International Space Station and for interplanetary exploration class missions, such as a human mission to Mars. Fully effective countermeasures to this problem have not yet been developed. To test the hypothesis that alpha-adrenergic stimulation might provide an effective countermeasure, we conducted a 16-day head-down-tilt bed-rest study (an analog of weightlessness) using normal human volunteers and administered the alpha(1)-agonist drug midodrine at the end of the bed-rest period. Midodrine was found to significantly ameliorate excessive decreases in blood pressure and presyncope during a provocative tilt test. We conclude that midodrine may be an effective countermeasure for the prevention of orthostatic intolerance following spaceflight.

Adrenergic alpha-Agonists↗
PubMed2000

Midodrine: a selective alpha-adrenergic agonist for orthostatic hypotension and dialysis hypotension.

Midodrine is an oral agent which acts as a selective peripherally-acting alpha-receptor agonist. Midodrine is a prodrug that is almost completely absorbed after oral administration and converted into its active drug de-glymidodrine in the systematic circulation, with a bioavailability of 93%. It has been used successfully in the treatment of neurogenic orthostatic hypotension and more recently, in the treatment of dialysis hypotension. It acts through vasoconstriction of the arterioles and the venous capacitance vessels, thereby increasing peripheral vascular resistance and augmenting venous return, respectively. It is a unique agent in the armamentarium against orthostatic hypotension since it has minimal cardiac and CNS effects. This article will review the literature on midodrine for conditions of autonomic dysfunction, with focus on recent studies on its use in haemodialysis patients.

Adrenergic alpha-Agonists↗
PubMed1983

The effect of midodrine and its active metabolite ST 1059 on the human urethra in vitro and in vivo.

The directly acting alpha-receptor agonist midodrine is active through its metabolite ST 1059. The effects of ST 1059 were investigated in vitro on strips of human urethra and on small human omental arteries. ST 1059 was as potent as noradrenaline on the isolated urethra, but had only 40% of noradrenaline's maximum activity. In omental arteries noradrenaline was at least ten times more potent than ST 1059 which only had about one fourth of noradrenaline's maximum activity. Compared to its effect on the vessels ST 1059 was ten times more effective on the urethra, whereas noradrenaline was slightly more effective on the vessels than on the urethra. Thus, in vitro St 1059 exhibited some selectivity for urethral alpha-receptors. When midodrine was given to 13 female patients with stress incontinence in the doses 2.5 mg and 5 mg x 3 for two weeks, only two had a positive urethral closure pressure during treatment and were subjectively improved. There were no effects on blood pressure and heart rate; one patient complained of pilo-erection. Two further patients received 7.5 mg x 3 for two weeks; both were subjectively improved but complained of pronounced pilo-erection. Only one of them had a positive urethral closure pressure during treatment. Blood pressure or heart rate did not change. Although it cannot be excluded that midodrine can increase intraurethral pressure with minor effects on blood pressure, it seems as the doses needed cause pilo-erection to an extent that limits the clinical usefulness of the drug.

Adult↗
PubMed2001

[Pharmacologic stimulation of ejaculation with midodrine hydrochloride (Gutron) for medically assisted reproduction in spinal injury].

INTRODUCTION: Midodrine hydrochloride (Gutron) is proposed to induce ejaculation in spinal injury patients desiring paternity as an alternative to vibromassage, electrostimulated ejaculation and surgical collection of spermatozoa. The authors report their experience in 10 spinal injury patients. PATIENTS AND METHODS: 14 trials of pharmacologically-induced ejaculation were performed in a context of medically assisted reproduction (MAR) in 10 spinal injury patients (7 with paraplegia > T11; 1 with paraplegia < or = T11; 2 with quadriplegia) an average of 4.5 years after the injury. Patients had a mean age of 28.5 years (range: 18 to 36 years). Nine had persistent reflex erections. After IC injection of prostglandin E, 10 to 30 mg of Gutron was administered by slow i.v. infusion. Spermatozoa were collected during antegrade ejaculation and/or in previously alkalinised urine. RESULT: Ejaculation was obtained in 10 cases (71.4%), either antegrade (7 cases), or retrograde (3 cases). The 4 failures corresponded to ejaculation failure in 3 cases and adverse effects of Gutron (hypertension) in 1 case. However, storage of spermatozoa could be performed in only 4 cases (40%), as pyospermia or severe necrospermia were observed in 6 cases. CONCLUSIONS: Midodrine hydrochloride gives good results in terms of ejaculation in spinal injury patients. However, the quality of semen collected is often poor due to the long interval since the initial trauma. Midodrine hydrochloride, ideally used after antibiotic treatment, can nevertheless constitute an alternative to other techniques.

Adolescent↗
PubMed1987

The effects of midodrine and alpha-2,5-dimethoxyphenyl-beta-aminoethanol hydrochloride on the rat uterus in situ.

In urethane anaesthetized rats 1 mg/kg i.v. alpha-2,5-dimethoxyphenyl-beta-glycinamidoethanol hydrochloride (midodrine, Gutron) or 0.1 mg/kg of its main metabolite alpha-2,5-dimethoxyphenyl-beta-aminoethanol hydrochloride (ST 1059) do not increase the uterine motility while these doses elevate the arterial blood pressure, 5 mg/kg midodrine or 0.3 mg/kg ST 1059 increase the uterine motility with concomitant increases in blood pressure and decreases in heart rate. It is concluded that midodrine does not enhance the uterine activity in doses clinically used for the treatment of hypotensive circulatory disorders.

Adrenergic alpha-Agonists↗
PubMed1993

Midodrine in neurogenic orthostatic hypotension. A new treatment.

Neurogenic orthostatic hypotension is a severely disabling condition due to deficient peripheral vasoconstrictor tone in response to the upright position and is characterized by a decrease in blood pressure upon standing associated with symptoms of lightheadedness, dizziness, visual "white-out", weakness, lack of energy, near syncope or even syncope. Previous pharmacologic treatment of neurogenic orthostatic hypotension has been problematic. Midodrine, a new specific alpha-1-agonist has been shown to produce arteriolar constriction and decrease in venous pooling via a constriction of venous capacitance vessels. Therefore, a recent multicenter study evaluated the safety and efficacy of midodrine therapy in 97 patients with neurogenic orthostatic hypotension due to various etiologies: Shy Drager syndrome (No. 18); Bradbury Eggleston syndrome (idiopathic orthostatic hypotension) (No. 20); diabetic autonomic neuropathy (No. 27); Parkinson's disease (No. 22); and miscellaneous (No. 10). Following one week of placebo therapy, the patients were randomized into 4 groups for a 4 week period of time; placebo, 2.5 mg, 5 mg, or 10 mg three times daily. The BE/SDS subgroup demonstrated a 27 +/- 8% (22 mmHg) increase in standing systolic blood pressure for the 10 mg dose. Diabetics achieved a significant increase at 5 mg. Similar increases were observed for the entire group on the 10 mg dose (p < 0.001). Symptoms or fainting, blurred vision, improved energy level, standing time, and depressed feelings were also significantly improved even at lower doses (p < 0.05 or less). Side effects were mild. Therefore, midodrine is an effective and safe agent for the treatment of neurogenic orthostatic hypotension.

Adrenergic beta-Antagonists↗
PubMed1979

Plasma level of the prodrug midodrine and its active metabolite in comparison with the alpha-mimetic action in dogs.

Midodrine, i.v. or orally administered, causes a prolonged elevation of blood pressure and a reduction in heart rate. These cardiovascular changes are not correlated to the plasma levels of the intact drug. On administration of either midodrine or its metabolite, ST-1059, formed by cleavage of the glycine residue, the elevation of blood pressure and the reduction in heart rate were significantly correlated to the plasma level of ST-1059. The results are in agreement with the assumption that the pressor activity of midodrine is mainly exerted by its metabolite ST-1059.

Adrenergic alpha-Agonists↗
PubMed1989

Quantification of midodrine and its active metabolite in plasma using a high performance liquid chromatography column switching technique.

An automated column-switching HPLC system is described for the simultaneous determination of midodrine, an alpha-adrenergic stimulating drug, and its active metabolite, ST-1059. Serum or plasma (850 microliters) is directly injected onto a RP18 (30 micrograms particle size) pre-column (9 x 4 mm ID) which acts as an on-line liquid-solid extractor and analyte enrichment system. The injection is followed by washing steps. The fraction containing the analytes is transferred onto an analytical RP18 column via step gradient elution where the final analysis is performed. Fluorescence detection is used (lambda ex 290 nm and lambda em 322 nm), and method detection limits of 0.8 ng/mL plasma were reached. These were sufficiently low to determine the plasma concentration-time profiles for both compounds following oral administration of 2.5 mg and 5 mg midodrine hydrochloride. The assay in serum or plasma was linear in the range of 1 to 15 ng analyte/mL, the recovery was greater than 95%, and the reproducibility was sufficient. The assay was rugged and was maintained by routinely changing the home-made, dry packed pre-column every 20th serum injection.

Chemical Phenomena↗
PubMed2004

Midodrine, octreotide, albumin, and TIPS in selected patients with cirrhosis and type 1 hepatorenal syndrome.

Hepatorenal syndrome (HRS) is a functional renal disorder complicating decompensated cirrhosis. Treatments to date, except liver transplantation, have been able to improve but not normalize renal function. The aim of this study was to determine the efficacy of transjugular intrahepatic portosystemic stent shunt (TIPS) as a treatment for type 1 HRS in ascitic cirrhotic patients, following improvement in systemic hemodynamics with a combination of midodrine, octreotide, and albumin (medical treatment). Fourteen ascitic cirrhotic patients with type 1 HRS received medical therapy until their serum creatinine reached below 135 micromol/L for at least 3 days, followed by a TIPS if there were no contraindications. Patients were assessed before and after medical treatment, as well as at 1 week and 1, 3, 6, and 12 months post-TIPS with measurements of renal function, sodium handling, systemic hemodynamics, central blood volume, and hormonal markers. Medical therapy for 14 +/- 3 days improved renal function (serum creatinine: 233 +/- 29 micromol/L vs. 112 +/- 8 micromol/L, P =.001) and renal sodium excretion (5 +/- 2 mmol/d vs. 9 +/- 2 mmol/d, P =.002) in 10 of the 14 patients. TIPS insertion in five of the responders further improved renal function and sodium excretion, so that by 12 months post-TIPS, glomerular filtration rate (96 +/- 20 mL/min, P <.01 vs. pre-TIPS) and urinary sodium excretion (119 +/- 15 mmol/d, P <.01 vs. pre-TIPS) were normal, associated with normalization of plasma renin and aldosterone levels and elimination of ascites. In conclusion, TIPS is an effective treatment for type 1 HRS in suitable patients with cirrhosis and ascites, following the improvement of renal function with combination therapy of midodrine, octreotide, and albumin.

Adrenergic alpha-Agonists↗
PubMed1991

Idiopathic orthostatic hypotension, midodrine, and anaesthesia.

A patient with idiopathic orthostatic hypotension receiving chronic oral midodrine therapy required anaesthesia for coronary artery bypass grafting. A perioperative infusion of phenylephrine was substituted for midodrine, an alpha-2 agonist, enabling hypotension resulting from low systemic vascular resistance to be controlled easily. Anticipated adrenergic receptor denervation hypersensitivity was noted. The only significant perioperative problem was one episode of syncope from orthostatic hypotension during the reambulation period.

Anesthesia, Intravenous↗