EFFICACY OF MIDODRINE HYDROCHLORIDE IN NEUROCARDIOGENIC SYNCOPE REFRACTORY TO STANDARD THERAPY

Midodrine for Refractory Neurocardiogenic Syncope. Introduction: Some patients ,vith neurocardiogenic syncope continue to have recurrent syn cope or presyncope despite the use of currently available drug therapy , The purpose of this study was to determine whether midodrine hydroch loride, a selective adrenergic agonist, could be effective in patients resistant to, or intolerant of, currently used medications in the tre atment of neurocardiogenic syncope. Methods and Results: Eleven patien ts with a history of recurrent syncope or presyncope in whom hypotensi on with syncope or presyncope could be provoked during head-up tilt te sting were included. There were 4 men and 7 women with a mean age (+/- SD) age of 34 +/- 13 years, In all patients, standard therapy with be ta-adrenergic receptor blocking agents, ephedrine, theophylline, disop yramide, fludrocortisone, and sertraline hydrochloride, was either ine ffective, poorly tolerated, or contraindicated. Midodrine was initiall y administered orally at a dose of 2.5 mg three times daily. After adj ustment of dosage over 2 to 4 weeks, patients were followed-up clinica lly. Midodrine was discontinued in one patient because of side effects . Frequency of syncope or presyncope during the 3 months prior to star ting treatment was compared during a mean follow-up of 17 +/- 3 weeks after starting treatment with midodrine. There was significant (P < 0. 01) reduction in syncopal and presyncopal episodes on midodrine. Five patients had complete resolution of symptoms, while four patients had significant improvement. Symptoms did not improve in one patient. Conc lusions: Midodrine hydrochloride can be effective in preventing recurr ent symptoms in selected patients with neurocardiogenic syncope unresp onsive to, or intolerant of, standard drug therapy.