Preliminary observations on the use of midodrine hydrochloride in the treatment of refractory neurocardiogenic syncope

Recurrent episodes of neurocardiogenic syncope that occur without warning a re a common cause of recurrent syncope that can be identified during head u pright tilt table testing. While the use of beta blockers, theophyllines, f ludrocortisone, disopyramide, and serotonin reuptake inhibitors can be usef ul in the prevention of episodes, some patients are either unresponsive to or poorly tolerant of these agents. We investigated the use of the peripher al alpha stimulating agent midodrine in preventing both tilt-induced and sp ontaneous neurocardiogenic syncope. Twenty-five patients (16 women, 9 men, mean age 30 +/- 23 years) with severe recurrent syncope and a positive head upright tilt table study (refractory to or intolerant of standard therapie s) were placed on midodrine 5-10 mg orally three times per day, (two patien ts required 15 mg/day). Of these, twelve became asymptomatic and five had a marked reduction in symptoms. We conclude that midodrine may be an effecti ve therapy in patients with recurrent neurocardiogenic syncope refractory t o other forms of therapy.