Usefulness of midodrine in patients with severely symptomatic neurocardiogenic syncope: a randomized control study
Open accessAbstract
Midodrine for Neurocardiogenic Syncope. Introduction: The efficacy of midodrine for the management of patients with neurocardiogenic syncope was assessed prospectively in a randomized control study. Methods and Results: Patients who had at least monthly occurrences of syncope and a positive tilt‐table test were included in the study. A total of 61 patients were randomly allocated to treatment either with midodrine or with fluid, salt tablets, and counseling. Midodrine was given at a starting dose of 5 mg three times a day and increased up to a dose of 15 mg three times a day when required. Midodrine was given during the daytime every 6 hours. Thirty‐one patients were assigned to treatment with midodrine; the other 30 patients were advised to increase their fluid intake and were instructed to recognize their prodromes and abort the progression to syncope. Patients were followed‐up for at least 6 months. A quality‐of‐life questionnaire was administered at the time of randomization and 6 months after. At the 6‐month follow‐up, 25 (81%) of 31 midodrine‐treated patients and 4 (13%) of the 30 fluid‐therapy patients had remained asymptomatic (P < 0.001). One patient had to discontinue taking midodrine due to severe side effects and another six patients experienced minor side effects that did not require drug discontinuation. Conclusion: Midodrine appeared to provide a significant benefit in patients with neurocardiogenic syncope. To prevent recurrence of symptoms, dose adjustments were required in about one third of patients.
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Four randomized trials of midodrine have shown a consistent risk reduction of approximately 70%.
“Four randomized trials on midodrine have shown a consistent risk reduction of approximately 70%.”
From 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope (2015) · cites this paper as [126]
The Results report a 78% risk reduction in this randomized trial, broadly consistent with the claimed approximate 70%. This paper reports one trial; its Results and Present Study sections do not establish that four randomized trials found a consistent reduction. (LLM, conf=0.88)
Experimental — accuracy not yet measuredNone of the midodrine studies were conventional placebo-controlled randomized clinical trials of moderately to severely symptomatic patients.
“None of the studies were conventional, placebo-controlled, randomized clinical trials of moderately to severely symptomatic patients.125–128”
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- Authors
- PEREZ‐LUGONES, A., SCHWEIKERT, R., PAVIA, S., SRA, J., AKHTAR, M., JAEGER, F., TOMASSONI, G. F., SALIBA, W., LEONELLI, F. M., BASH, D., BEHEIRY, S., SHEWCHIK, J., TCHOU, P. J., & NATALE, A.
- Affiliations
- Cleveland Clinic (US)
- Central Baptist Hospital (US)
- Corresponding author
- NATALE, ANDREA
- Venue
- Journal of Cardiovascular Electrophysiology
- Publisher
- Wiley
- Published
- 2001-08
- Volume
- 12
- Issue
- 8
- Pages
- 935-938
- ISSN
- 1045-3873 (ISSN-L)
- 1540-8167
- OpenAlex
- W2145507145
- Cited by
- 164
- References
- 9
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 1 · 2022: 5 · 2021: 7 · 2020: 3 · 2018: 5 · 2017: 10 · 2016: 2 · 2015: 7 · 2014: 8 · 2013: 8 · 2012: 11
- FWCI
- 8.25
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Cardiovascular Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
- Keywords
- midodrine, vasovagal syncope, tilt table test, quality of life, adverse drug reactions, dose adjustment, syncope prevention
- MeSH terms
- Adrenergic alpha-Agonists, Adult, Dose-Response Relationship, Drug, Female, Follow-Up Studies, Humans, Kentucky, Male, Middle Aged, Midodrine, Prospective Studies, Quality of Life, Surveys and Questionnaires, Recurrence, Severity of Illness Index, Wisconsin, Treatment Outcome, Syncope, Vasovagal
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