Skip to main navigation
Skip notifications
Access to POEMs and Essential Evidence Plus will no longer be included in CMA membership as of Dec. 1, 2023.
Search
Midodrine is worth a trial in people with frequent episodes of vasovagal syncope
Clinical Question
Can midodrine decrease recurrent episodes of vasovagal syncope?
Bottom line
Midodrine, a vasoconstrictor used to prevent orthostatic hypotension, may reduce the likelihood of recurrence of vasovagal syncope in patients who have episodes fairly often. It seems to either work completely or not at all; during this study, the patients who had at least one episode of syncope had several episodes over the course of the year regardless of whether they received midodrine or placebo. 1b-
Reference
Study design: Randomized controlled trial (double-blinded)
Funding: Industry + govt
Setting: Outpatient (specialty)
Synopsis
These investigators enrolled 133 adults without orthostatic hypotension who had fainted at least twice (median = 6 times) in the past year and who did not have other known causes of syncope, including orthostatic hypotension. Patients were randomized, concealed allocation unknown, to receive either placebo or midodrine for one year. Either treatment was started at 5 mg 3 times daily during daylight hours, with the dose increased up to 10 mg 3 times daily, if tolerated. Over one year, 58% of patients in the midodrine group were syncope-free as compared with 39% in the placebo group (number needed to treat = 5). Midodrine treatment was also associated with a longer time to first recurrence of syncope (P = .035). In the subset of participants who had at least one syncope episode during the study, the rates were similar between treatments (3.6 - 3.8 episodes per year).
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
Midodrine - Syncope
Insufficient information on other concurrent medications used by the participants - e.g. anti-hypertensives
Midodrine
This is a very precarious diagnosis . I believe that this is a haphazard way to deal with the problem and could miss serious pathology
"Midodrine is worth a trial in patients with frequent episod
The study and the bottom line reported that the vasoconstrictor midodrine decreased the frequency of symptomatic vasovagal symptoms. There was no mention of side effects. A vasoconstrictor could be expected to worsen Raynaud's disease and also potentially increase the likelihood of acute coronary syndrome and stroke. Did the study exclude people with Raynaud's disease, or a recent history of acute coronary sydrome or a recent history of stroke?
mitodrine and vasovagal syncope
it may decrease incidence of syncope over 1 year