Midodrine appears to be safe and effective for dialysis-induced hypotension: a systematic review

Prakash, Suma; Garg, Amit X.; Heidenheim, A. Paul; House, Andrew A.

doi:10.1093/ndt/gfh420

Cited by 137 publications

(106 citation statements)

References 15 publications

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“…It has been safely and successfully used in patients with end-stage kidney disease whose hypotension would otherwise have compromised chronic dialysis. 15 Furthermore, it was successfully used to treat hypotension secondary to stunned myocardium post-infarction. 16 Its use in patients with HF is not known.…”

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confidence: 99%

The Use of Midodrine in Patients With Advanced Heart Failure

Zakir

Folefack

Sarić

et al. 2009

Congestive Heart Failure

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In many patients, the treatment of heart failure (HF) cannot be optimized because of pre‐existing or treatment‐induced hypotension. Midodrine, a peripheral α1‐adrenergic agonist may allow for up‐titration of neurohormonal antagonist therapy leading to improved outcomes. Ten consecutive patients with HF due to systolic dysfunction and symptomatic hypotension interfering with optimal medical therapy were started on midodrine. After a 6‐month follow‐up, a higher percentage of patients were on optimal HF therapy (angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker mg % of optimal dose 20% vs 57.5%; P<.001) (β‐blockers mg % optimal dose 37.5% vs 75%; P<.001) (spironolactone/eplerenone mg % 43.7% vs 95%; P<.001). This led to an improvement in left ventricular ejection fraction (baseline 24±9.4 vs 32.2±9.9; P<.001) and clinical outcomes, with a significant reduction in total hospital admissions (32 vs 12; P=.02) and total hospital days (150 vs 58; P=.02).

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mentioning

confidence: 99%

The Use of Midodrine in Patients With Advanced Heart Failure

Zakir

Folefack

Sarić

et al. 2009

Congestive Heart Failure

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“…Alt ho ugh it has been shown that mi dod ri ne, an oral se lec ti ve alp ha-1 ad re ner gic ago nist, ef fecti vely pre vents hypo ten si on du ring HD in so me recent stu di es, 2,3,8,[16][17][18] only two stu di es ha ve be en re por ted which des cri be its ef fects on HD pa ti ents with chro nic hypo ten si on. 5,9 This disagreement may be re la ted to cha rac te ris tics of the pa ti ent popu la ti on, study de sign and the do se of mi dod ri ne given.…”

Section: Discussionmentioning

confidence: 99%

“…7 Mo re re cently, mi dod ri ne, an oral se lec ti ve alp ha-1 ad re ner gic ago nist, has be en success fully used in the tre at ment of di aly sis hypoten si on, es pe ci ally in com bi na ti on with co o ling di aly sa te. 8 Ho we ver, the re is li mi ted ex pe ri en ce with the use of mi dod ri ne in HD pa ti ents with chro nic hypo ten si on, even no ex pe ri en ce with dia be tic sub set of HD pa ti ents. 1,5,9 For this re a son, we tri ed to de mons tra te the ef fect of mi dod ri ne tre at ment on di a be tic HD pa ti ents with chro nic hypo ten si on.…”

mentioning

confidence: 99%

The Effect of Midodrine Hydrochloride on Chronic Hypotension in Patients with Diabetes Mellitus Undergoing Hemodialysis Therapy

Sarikaya¹,

Sarı²,

Güneş³

2011

Turkiye Klinikleri J Med Sci

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A AB BS S T TR RA AC CT T O Ob b j je ec c t ti i v ve e: Chro nic hypo ten si on is a com mon comp li ca ti on of he mo di aly sis in pa ti ents with di a be tes mel li tus. Mi dod ri ne hydroch lo ri de is an alp ha-1 ago nist that ef fec ti vely cor rects intra di aly tic hypo ten si ve at tacks. However, the ef fect of mi dod ri ne on chro nic hypo ten si on is still unk nown in he mo di aly sis pa ti ents. In the pre sent study, we ai med to eva lu a te the ef fects of mi dod ri ne tre at ment on chro nic hypo ten si on in pa ti ents with di a be tes mel li tus undergoing he mo di aly sis. M Ma a--t te e r ri i a al l a an nd d M Me et t h ho od ds s: A to tal of 21 di a be tic pa ti ents un der go ing he mo di aly sis and had chro nic hypo ten si on (systo lic blo od pres su re <100 mmHg be fo re di aly sis) we re inc lu ded in the study. Mi dod ri ne was given 5 mg p.o. twi ce a day and 5 mg be fo re every di aly sis ses si on to all pa ti ents. Blo od pres su res (pre-he mo di aly sis systo lic, di as to lic and me an ar te ri al pres su re) we re me a su red. In tra-di aly tic hypo ten si on at tacks, ort hos ta sis, diz zi ness, fa ti gu e, blur red vi si on, dull ness, and he a dac he we re re cor ded. Da ta ob ta i ned be fo re mi dod ri ne the rapy we re com pa red to tho se collec ted at the 3 rd month of he mo di aly sis when the patients were under mi dod ri ne the rapy. R Re e s su ul lt ts s: : Pre-di aly sis systo lic, di as to lic and me an ar te ri al blo od pres su res, ver ti go and synco pe at tacks were sig ni fi cantly (p< 0.05) im pro ved by mi dod ri ne the rapy. No sig ni fi cant dif fe ren ce was se en in mean ul tra-fil tra ti on vo lu me per he mo di aly sis ses si on and num ber of in tra-di aly tic hypo ten si ve at tacks ac cor ding to ba se li ne va lu es over the co ur se of study (p>0.05). C Co on nc c l lu u s si i o on n: : Mi dod ri ne ap pe ars to be an ef fec ti ve and sa fe tre at ment op ti on in di a be tic he mo di aly sis pa ti ents with sympto ma tic chro nic hypo ten si on, but it has no ef fect on in tra-di aly tic hypo ten si ve at tacks. K Ke ey y W Wo or rd ds s: : Di a be tes mel li tus; hypo ten si on; re nal di aly sis; Mi dod ri ne Ö ÖZ ZE ET T A Am ma aç ç: Kro nik hi po tan si yon di ya bet li has ta lar da he mo di ya li zin sık gö rü len bir komp li kasyo nu dur. Mi dod rin hid rok lo rid di ya liz sı ra sın da ki hi po tan sif atak la rı et ki li şekil de dü zel ten al fa-1 ago nist bir ilaç tır. Fa kat he mo di ya liz has ta la rın da mi dod ri nin kro nik hi po tan si yon da ki et ki si ha len bi lin me mek te dir. Bu ça lış ma da mi dod rin te da vi si nin he mo di ya liz te da vi si alan di ya bet has ta la rın -da kro nik hi po tan si yo na et ki le ri ni de ğer len dir me yi amaç la dık. G Ge e r re eç ç v ve e Y Yö ön n t te em m l le er r: Kro nik hi potan si yo nu olup (di ya liz den ön ce sis to lik kan ba sın cı <100 mmHg) he mo di ya liz te da vi si alan top lam 21 di ya be tik has ta ça lış ma ya alın dı. Tüm has ta la ra gün de iki kez ...

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“…Furthermore, this drug is beneficial in preventing or ameliorating the symptoms of intradialytic hypotension (Prakash et al, 2004). There are many reports regarding the pharmacological and clinical effects of midodrine, but its pharmacokinetic properties, especially the mechanism behind its intestinal absorption, have not been elucidated.…”

Section: Discussionmentioning

confidence: 99%

Transport Characteristics of a Novel Peptide Transporter 1 Substrate, Antihypotensive Drug Midodrine, and Its Amino Acid Derivatives

Tsuda

Takato²,

Irie³

et al. 2006

J Pharmacol Exp Ther

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Midodrine is an oral drug for orthostatic hypotension. This drug is almost completely absorbed after oral administration and converted into its active form, 1-(2Ј,5Ј-dimethoxyphenyl)-2-aminoethanol) (DMAE), by the cleavage of a glycine residue. The intestinal H ϩ -coupled peptide transporter 1 (PEPT1) transports various peptide-like drugs and has been used as a target molecule for improving the intestinal absorption of poorly absorbed drugs through amino acid modifications. Because midodrine meets these requirements, we examined whether midodrine can be a substrate for PEPT1. The uptake of midodrine, but not DMAE, was markedly increased in PEPT1-expressing oocytes compared with water-injected oocytes. Midodrine uptake by Caco-2 cells was saturable and was inhibited by various PEPT1 substrates. Midodrine absorption from the rat intestine was very rapid and was significantly inhibited by the high-affinity PEPT1 substrate cyclacillin, assessed by the alteration of the area under the blood concentration-time curve for 30 min and the maximal concentration. Some amino acid derivatives of DMAE were transported by PEPT1, and their transport was dependent on the amino acids modified. In contrast to neutral substrates, cationic midodrine was taken up extensively at alkaline pH, and this pH profile was reproduced by a 14-state model of PEPT1, which we recently reported. These findings indicate that PEPT1 can transport midodrine and contributes to the high bioavailability of this drug and that Gly modification of DMAE is desirable for a prodrug of DMAE.

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Midodrine appears to be safe and effective for dialysis-induced hypotension: a systematic review

Abstract: This systematic review would suggest that midodrine has a role in the therapy of haemodialysis patients experiencing IDH. This conclusion must be viewed with caution, however, given the quality and sample size of the studies included in this review.

Cited by 137 publications

References 15 publications

The Use of Midodrine in Patients With Advanced Heart Failure

The Use of Midodrine in Patients With Advanced Heart Failure

The Effect of Midodrine Hydrochloride on Chronic Hypotension in Patients with Diabetes Mellitus Undergoing Hemodialysis Therapy

Transport Characteristics of a Novel Peptide Transporter 1 Substrate, Antihypotensive Drug Midodrine, and Its Amino Acid Derivatives

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