Lawrence B Gutman Ben Wilson


Midodrine is an oral, peripherally acting alpha-adrenergic agonist. After gaining Food and Drug Administration (FDA) approval in 1996 for orthostatic hypotension, its use has evolved to target vasoplegic conditions such as intradialytic hypotension in the end-stage renal disease (ESRD) population, refractory ascites in cirrhotic patients to support diuresis, and in hepatorenal syndrome.


Upon oral ingestion, the drug undergoes enzymatic hydrolysis to an active metabolite, desglymidodrine. Its use has been well tolerated at 2.5 mg, 5 mg and 10 mg oral doses. The most frequently occurring side effects relate directly to it’s sympathomimetic profile and include piloerection, scalp pruritis, generalized paresthesias and urinary retention.


The vasoplegic profile of sepsis would be a potential target for midodrine therapy. While there has been suggestion for its use to mediate recovery from septic shock, there is a paucity of clinical data supporting its use. Such therapy may be uniquely appropriate in septic patients who are not candidates for intenstive care unit (ICU) level of care.