Midodrine treatment in children with recurrent vasovagal syncope

Abstract

Background: Vasovagal syncope is the most common cause of syncope in childhood and its treatment is not at a satisfactory level yet. We aimed to investigate patients who were diagnosed with vasovagal syncope, did not benefit from conventional treatment, received midodrine treatment, and to evaluate their response to midodrine treatment. Methods: Files of 24 patients who were diagnosed with recurrent vasovagal syncope, did not benefit from non-pharmacological treatments, and received midodrine treatment during June 2017–October 2019 were retrospectively analysed. Results: In total, 24 patients received a treatment dose of midodrine at 5 mg/day (2.5 mg BID) included in the study. The mean number of syncope was 5.75 ± 2.67 prior to treatment. Following treatment, the mean number of syncope was 0.42 ± 0.89. It was observed that syncope episodes did not recur in 17 patients, but it recurred in 4 out of 7 patients in the first 3 months of the treatment and did not recur in the following months. The episodes improved in two patients with an increase in the treatment dose, but the syncope episodes continued in only one patient. Conclusion: It was concluded that midodrine treatment was effective and safe in adolescents with recurrent vasovagal syncope.

Adult vasovagal syncope with abdominal pain diagnosed by head-up tilt combined with transcranial doppler: a preliminary study

“…Additionally, the use of progressively prolonged periods of enforced upright posture, known as “tilt training,” may reduce syncope recurrence in highly motivated patients with recurrent vasovagal symptoms [ 32 ]. Other therapies for VVS include increased salt and water intake and various drug treatments (such as atenolol [ 33 ] and midodrine [ 34 ]). Furthermore, the effectiveness of β-blockers in preventing VVS has been found to be age-dependent, with potential effectiveness in older patients [ 35 ].…”

Midodrine reduces new‐onset acute kidney injury and hyponatremia in children with cirrhosis and ascites awaiting liver transplantation: Results from an open‐label RCT

“…Midodrine offers a major advantage over other vasoconstrictors due to its oral administration, avoiding the need for hospitalization, lower cost, and relative safety compared to other splanchnic vasoconstrictors 2–5 . Previous use of midodrine in children with vasovagal syncope and postural tachycardia syndrome has demonstrated safety, although the optimal pediatric dosage remains unclear 18,19 …”

Calcitonin gene-related peptide predicts therapeutic response to midodrine hydrochloride in children with vasovagal syncope

“…Midodrine is an approved agent for orthostatic hypotension management in the United States ( Low et al, 1997 ), the beneficial effects of midodrine have been confirmed in a series of studies on adult VVS ( Samniah et al, 2001 ; Kaufmann et al, 2002 ). However, the efficacy of midodrine hydro-chloride in children and adolescents is variable ( Mitro et al, 1999 ; Kaufmann et al, 2002 ; Qingyou et al, 2006 ; Romme et al, 2011 ; Bagrul et al, 2021 ). Great improvements were achieved in terms of individualized therapies and before the application of any treatment, biological markers or predictors could provide useful information for doctors to choose a specific treatment regimen.…”