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• W1544076046 abstract "To the Editor: Midodrine hydrochloride, an alpha 1-adrenergic receptor agonist that increases peripheral blood pressure by constricting arterial and venous beds, has been shown to be effective in the management of syncope in adults with orthostatic hypotension,1,2 vasovagal syncope,3–6 and vasodepressor carotid sinus syndrome,7 although its use, tolerability, and side effects have not been monitored specifically in older adults, particularly not over a prolonged period of time.8 Data are reported from a prospective registry of 135 consecutive elderly subjects (mean age 84) referred to a geriatric unit for assessment of syncope or unexplained falls from January 1, 2001, to January 1, 2005. All patients referred to the unit underwent investigation according to European Society of Cardiology guidelines.9 Patients who had a suspected diagnosis of neurally mediated syncope or had falls that remained unexplained and were severe or frequent underwent tilt table testing and carotid sinus massage maneuvers based upon a variation of a protocol established previously.10 Of 290 patients evaluated during the study period, 52 men and 83 women aged 64 to 97 who had a clinically significant tilt table test or carotid sinus massage and severe symptoms and remained symptomatic after standard treatments (e.g., patient education, physical counter-pressure maneuvers to abort imminent faints, advice on salt intake and hydration, avoidance of situational triggers, and standing training) were offered midodrine, initially at a dose of 2.5 mg three times a day. Dose was titrated up at clinic visits in increments of 2.5 mg, and patients were monitored for a median length of time of 2.7 years. Ninety-seven individuals (71%) reported cessation or significant reduction in their symptoms for all of the tilt table diagnoses (Figure 1), and 29% reported no benefit. Thirty-four subjects (25%) had stopped taking the drug by the end of follow-up: failure to maintain symptom control (n=14), inability to keep patient appointments (n=7), significant clinical deterioration unrelated to midodrine (n=7), and adverse drug reactions (n=6). Of the remaining 101 individuals taking midodrine until the end of follow-up, 49% received 2.5 mg three times per day, 30% required 5 mg three times daily, and 21% required higher dosages. Incidences of adverse drug reactions were assessed at each clinic visit, and although 19 patients reported drug-related side effects, only six ceased taking midodrine, whereas 13 continued treatment. Reasons for drug discontinuation were hypertension (n=3), lower urinary tract obstructive symptoms (n=1), palpitations (n=1), and nausea (n=1). Clinical improvement and tilt table and carotid sinus massage diagnoses. In conclusion, midodrine hydrochloride appears to be safe and well tolerated in older adults and should be considered in the management of patients with symptomatic orthostatic hypotension, vasovagal syncope, and vasodepressor or mixed carotid sinus syndrome independent of age after standard treatments have been tried. This observation requires further confirmation in randomized control studies. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: DP, AV, JS: concept and design, acquisition of subjects and data, analysis and interpretation of data, and preparation of manuscript. OA: acquisition of subjects, analysis and interpretation of data, and preparation of manuscript. EP: statistical design and analysis. QA: interpretation of data and preparation of manuscript. Sponsor's Role: No sponsor." @default.
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• W1544076046 date "2010-10-01" @default.
• W1544076046 modified "2023-09-27" @default.
• W1544076046 title "MIDODRINE HYDROCHLORIDE IS SAFE AND EFFECTIVE IN OLDER PEOPLE WITH NEUROCARDIOGENIC SYNCOPE" @default.
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• W1544076046 doi "https://doi.org/10.1111/j.1532-5415.2010.03069.x" @default.
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