Severe Hypertension and Bradycardia Secondary to Midodrine Overdose

Wong, Lee Yung; Wong, Anselm; Robertson, Thomas A.; Burns, Kevin D.; Roberts, Mary Ellen

doi:10.1007/s13181-016-0574-4

Cited by 13 publications

(5 citation statements)

References 12 publications

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“…Apart from delayed detection of deteriorating heart function, there may be other reasons contributing to the elevated mortality associated with midodrine usage. Firstly, excessive midodrine consumption can potentially lead to severe hypertension and reflex bradycardia ( Wong et al, 2017 ). A study involving ICU patients highlighted that bradycardia was the most prevalent adverse effect (15% for heart rate <50/min and 9% for heart rate <40/min) ( Rizvi et al, 2018 ).…”

Section: Discussionmentioning

confidence: 99%

Safety of midodrine in patients with heart failure with reduced ejection fraction: a retrospective cohort study

Wu,

Chen,

Tsai

2024

Front. Pharmacol.

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Background: Heart failure with reduced ejection fraction (HFrEF) poses significant health risks. Midodrine for maintaining blood pressure in HFrEF, requires further safety investigation. This study explores midodrine’s safety in HFrEF through extensive matched analysis.Methods: Patients with HFrEF (LVEF <50%) without malignancy, non-dialysis dependence, or non-orthostatic hypotension, were enrolled between 28 August 2013, and 27 August 2023. Propensity score matching (PSM) created 1:1 matched groups. Outcomes included mortality, stage 4 and 5 chronic kidney disease (CKD), emergency room (ER) visits, intensive care unit (ICU) admissions, hospitalizations, and respiratory failure. Hazard ratios (HR) with 95% confidence intervals (95% CI) were calculated for each outcome, and Kaplan-Meier survival analysis was performed. Subgroup analyses were conducted based on gender, age (20-<65 vs. ≥65), medication refill frequency, and baseline LVEF.Results: After 1:1 PSM, 5813 cases were included in each group. The midodrine group had higher risks of respiratory failure (HR: 1.16, 95% CI: 1.08–1.25), ICU admissions (HR: 1.14, 95% CI: 1.06–1.23), hospitalizations (HR: 1.21, 95% CI: 1.12–1.31), and mortality (HR: 1.090, 95% CI: 1.01–1.17). Interestingly, midodrine use reduced ER visits (HR: 0.77, 95% CI: 0.71–0.83). Similar patterns of lower ER visit risk and higher risks for ICU admissions, respiratory failure, and overall hospitalizations were observed in most subgroups.Conclusion: In this large-scale study, midodrine use was associated with reduced ER visits but increased risks of respiratory failure, prolonged ICU stays, higher hospitalizations, and elevated mortality in HFrEF patients. Further research is needed to clarify midodrine’s role in hemodynamic support and strengthen existing evidence.

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Section: Discussionmentioning

confidence: 99%

Safety of midodrine in patients with heart failure with reduced ejection fraction: a retrospective cohort study

Wu,

Chen,

Tsai

2024

Front. Pharmacol.

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“…Las manifestaciones clínicas secundarias a una sobredosis de midodrina se correlacionan con los mecanismos de acción del fármaco; las descritas con más frecuencia son bradicardia refleja, urgencia o retención urinaria, hipertensión supina y reacción pilomotora 11 . Sin embargo, la presentación clínica depende de la dosis administrada y su duración es secundaria al tiempo de eliminación del medicamento según sus características farmacocinéticas y farmacodinámicas 7 .…”

Section: Discussionunclassified

Crisis hipertensiva y bradicardia secundaria a intoxicación por midodrina

Patiño-Arboleda¹,

Negrete-Salcedo²,

Ocampo-Chaparro³

2022

RCCAR

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El síncope, definido como una pérdida transitoria de la conciencia que cursa con recuperación espontánea y completa, es secundario a un amplio grupo etiológico, incluido el de origen vasovagal desencadenado por una descarga adrenérgica u ortostatismo. El tratamiento de esta entidad incluye medidas no farmacológicas y farmacológicas, como la administración de midodrina, un agonista de los receptores α de acción periférica, usada en el control de la hipotensión ortostática y cuyo empleo ha demostrado mejoría en los síntomas de esta alteración. Se presenta el caso de una mujer de 18 años, con antecedente de síncope vasovagal en tratamiento con medidas no farmacológicas y midodrina desde seis meses antes, quien consultó al servicio de urgencias de un centro de atención de nivel IV por cuadro clínico consistente en ingestión intencionada de una sobredosis de midodrina. En el ingreso se documentaron crisis hipertensiva, bradicardia extrema y compromiso hepático y renal. Se indicó tratamiento sintomático con resolución de las alteraciones clínicas y paraclínicas e intervención del equipo de salud mental.

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“…Three doses of either placebo or midodrine 10 mg were administered orally every 8 hours, in addition to usual care for sepsis. This dose was chosen keeping in mind the side effects to midodrine such as bradycardia and masking the signs of hypoperfusion as seen in other studies ( 17 , 26 ). The medical provider, nursing staff, and patient were blinded to randomization; only research pharmacists were aware of randomization.…”

Section: Methodsmentioning

confidence: 99%

Oral Midodrine Administration During the First 24 Hours of Sepsis to Reduce the Need of Vasoactive Agents: Placebo-Controlled Feasibility Clinical Trial

Lal¹,

Trivedi²,

Rizvi³

et al. 2021

Critical Care Explorations

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Objectives: Our preliminary data and observational studies suggested an increasing “off label” use of oral midodrine as a vasopressor sparing agent in various groups of critically ill patients, including those with sepsis. We designed this clinical trial to evaluate the feasibility of use of midodrine hydrochloride in early sepsis to reduce the duration for IV vasopressors and decrease ICU and hospital length of stay. Design: Pilot, two-center, placebo-controlled, double blinded randomized clinical trial. Setting: Medical ICUs at Mayo Clinic Rochester and Cleveland Clinic Abu Dhabi were the study sites. Patients and Methods: Adult patients (≥ 18 yr old) were included within 24 hours of meeting the Sepsis-3 definition if the mean arterial pressure remained less than 70 mm Hg despite receiving timely antibiotics and initial IV fluid bolus of 30 cc/kg. Intervention: Three doses of 10 mg midodrine versus placebo were administered. Measurements and Main Results: Total 32 patients were randomized into midodrine ( n = 17) and placebo groups ( n = 15). There were no major differences in baseline variables between the groups except for higher baseline creatinine in the midodrine group (2.0 ± 0.9 mg/dL) versus placebo group (1.4 ± 0.6 mg /dL), p = 0.03. The median duration of IV vasopressor requirement was 14.5 ± 8.1 hours in midodrine group versus 18.8 ± 7.1 hours in the placebo group, p value equals to 0.19. Patients in the midodrine group needed 729 ± 963 norepinephrine equivalent compared with 983 ± 1,569 norepinephrine equivalent in the placebo group, p value equals to 0.59. ICU length of stay was 2.29 days (interquartile range, 1.65–3.9 d) in the midodrine group, compared with 2.45 days (interquartile range, 1.6–3.2 d) in the placebo group, p value equals to 0.36. No serious adverse events were observed in either group. Conclusions: Phase II clinical trial powered for clinical outcomes (duration of vasopressor use, need for central venous catheter, and ICU and hospital length of stay) is justified.

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Severe Hypertension and Bradycardia Secondary to Midodrine Overdose

Cited by 13 publications

References 12 publications

Safety of midodrine in patients with heart failure with reduced ejection fraction: a retrospective cohort study

Safety of midodrine in patients with heart failure with reduced ejection fraction: a retrospective cohort study

Crisis hipertensiva y bradicardia secundaria a intoxicación por midodrina

Oral Midodrine Administration During the First 24 Hours of Sepsis to Reduce the Need of Vasoactive Agents: Placebo-Controlled Feasibility Clinical Trial

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