Effect of Midodrine in Patients with Liver Cirrhosis and Refractory Ascites

Reply to: “Midodrine and albumin in decompensated cirrhosis: Down but not out…”

“…With respect to midodrine, in our trial this drug was administered at the recommended dose and schedule, which is starting at a low dose and increasing the dose based on changes in mean arterial pressure to a maximum of 30 mg/day. In fact, in the studies cited in this letter, 3,4 midodrine was used at a lower dose than the maximum used in our trial (22.5 mg/day and 12.5 mg/day, respectively). In our opinion, the major drawback of midodrine treatment was not only that the effect of treatment on mean arterial pressure was not strong enough, but that it was not persistent.…”

Midodrine and albumin in decompensated cirrhosis: Down but not out…

“…2 In another recent study in 78 patients with refractory ascites, there was better control of ascites and a significant increase in mean arterial pressure with a mean dose of 12.5 ± 2.5 mg/day of midodrine. 3 The authors also conclude that there were no significant differences in the probability of developing complications of cirrhosis during the study period. Although associated with a minor clinical impact, the current study did find that the episodes of hyponatremia and renal failure were more severe in patients in the placebo group compared to the M + A group.…”

Midodrine Improves the Tolerability of Diuretics in Patients with Acute-on-Chronic Liver Failure—A Pilot Study

“…2 Previously, two studies have evaluated midodrine in refractory ascites. 5,14 Singh et al demonstrated that midodrine at a fixed dose of 7.5 mg thrice daily significantly increased the MAP, decreased the plasma renin activity with better control of ascites after 1 month in 40 cirrhosis patients with refractory/recurrent ascites. Alcohol was the most common cause of cirrhosis, and the mean MELD was 14.…”