Usefulness of midodrine in patients with severely symptomatic neurocardiogenic syncope: A randomized control study

Introduction: The efficacy of midodrine for the management of patients with neurocardiogenic syncope was assessed prospectively in a randomized contro l study. Methods and Results: Patients who had at least monthly occurrences of synco pe and a positive tilt-table test were included in the study. A total of 61 patients were randomly allocated to treatment either with midodrine or wit h fluid, salt tablets, and counseling. Midodrine was given at a starting do se of 5 mg three times a day and increased up to a dose of 15 mg three time s a day when required. Midodrine was given during the daytime every 6 hours . Thirty-one patients were assigned to treatment with midodrine; the other 30 patients were advised to increase their fluid intake and were instructed to recognize their prodromes and abort the progression to syncope. Patient s were followed-up for at least 6 months. A quality-of-life questionnaire w as administered at the time of randomization and 6 months after. At the 6-m onth follow-up, 25 (81 %) of 31 midodrine-treated patients and 4 (13 %) of the 30 fluid-therapy patients had remained asymptomatic (P < 0.001). One pa tient had to discontinue taking midodrine due to severe side effects and an other six patients experienced minor side effects that did not require drug discontinuation. Conclusion: Midodrine appeared to provide a significant benefit in patients with neurocardiogenic syncope. To prevent recurrence of symptoms, dose adj ustments were required in about one third of patients.