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A double-blind, dose-response study of midodrine in neurogenic orthostatic hypotension
Abstract
OBJECTIVE: To determine the best therapeutic strategy for the use of midodrine in patients with neurogenic orthostatic hypotension (NOH). BACKGROUND: Midodrine is a peripherally acting alpha-adrenergic agonist useful in the treatment of NOH. However, neither the most effective dosage of midodrine nor the required frequency of administration is established. DESIGN/METHODS: Midodrine dose-blood pressure response, pharmacokinetics, and duration of action were examined in a double-blind, placebo-controlled, four-way crossover trial. Twenty-five patients with NOH were randomized to receive on successive days placebo or midodrine 2.5, 10, or 20 mg. Blood pressures of patients in the supine and standing positions were measured sequentially. A global assessment of the patient's overall symptom improvement after each leg of the study was performed. Blood levels of midodrine and its active metabolite, desglymidodrine, were assayed. RESULTS: Midodrine significantly increased standing systolic blood pressure, with the increase peaking at 1 hour. There was a significant linear relation between midodrine dosage and mean systolic blood pressure. The mean score for global improvement of symptoms was significantly higher for midodrine (10 and 20 mg) compared with placebo. The half-life of desglymidodrine was approximately 4 hours. CONCLUSION: A 10-mg dose of midodrine prescribed two to three times daily is effective in increasing orthostatic blood pressure and ameliorating symptoms in patients with NOH.
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“There is no doubt that midodrine increases BP both in the supine and upright posture, and ameliorates the symptoms of OH.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [326]
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“Midodrine (2.5-10 mg t.i.d) was shown to be effective in three randomized placebo-controlled trials. 324-326”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [326]
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Self-citation
Metadata
- Authors
- Wright, R. A., Kaufmann, H. C., Perera, R., Opfer-Gehrking, T. L., McElligott, M. A., Sheng, K. N., & Low, P. A.
- Affiliations
- Mayo Clinic (US)
- Venue
- Neurology
- Published
- 1998-07
- Volume
- 51
- Issue
- 1
- Pages
- 120-124
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- OpenAlex
- W2048764982
- Cited by
- 331
- References
- 5
- Citations by year
- 2026: 8 · 2025: 14 · 2024: 8 · 2023: 11 · 2022: 12 · 2021: 14 · 2020: 23 · 2019: 8 · 2018: 16 · 2017: 24 · 2016: 9 · 2015: 16 · 2014: 24 · 2013: 22 · 2012: 5
- FWCI
- 5.92
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Neurology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Mayo Foundation for Medical Education and Research
- National Institutes of Health (1p01ns032352-01a1)
- National Institute of Neurological Disorders and Stroke (P01 NS 32352)
- National Center for Research Resources (5MO RR00071)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- midodrine, neurogenic orthostatic hypotension, alpha-adrenergic agonists, dose-response relationship, pharmacokinetics, blood pressure, symptom improvement
- MeSH terms
- Adrenergic alpha-Agonists, Adult, Aged, Autonomic Nervous System Diseases, Dose-Response Relationship, Drug, Double-Blind Method, Female, Humans, Hypotension, Orthostatic, Male, Middle Aged, Midodrine, Cross-Over Studies
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