From the Research
Role of Midodrine in Septic Shock
- Midodrine is an oral, peripherally acting alpha-adrenergic agonist that has been used to target vasoplegic conditions such as septic shock 1.
- The vasoplegic profile of sepsis would be a potential target for midodrine therapy, and its use may be uniquely appropriate in septic patients who are not candidates for intensive care unit (ICU) level of care 1.
- A systematic review and meta-analysis found that adding midodrine to patients with septic shock was associated with a reduction in hospital mortality and ICU mortality 2.
Efficacy and Safety of Midodrine
- Midodrine may decrease ICU length of stay, duration of IV vasopressor therapy, and mortality in critically ill patients 3.
- However, the required sample size was not met to determine the outcomes of interest, and midodrine may increase the risk of bradycardia 3.
- A clinical trial found that oral midodrine administration during the first 24 hours of sepsis did not significantly reduce the need for vasoactive agents, but a phase II clinical trial powered for clinical outcomes is justified 4.
Clinical Utility of Midodrine
- Midodrine is an orally administered alpha-1 adrenergic agonist that can be used as a catecholamine-sparing agent in intensive care unit patients with shock 5.
- Several studies have evaluated the use of midodrine in patients with shock and found potential benefits in terms of causing significant elevations in blood pressure and hastening catecholamine vasopressor discontinuation with few adverse effects 5.
- However, robust evidence is lacking for the off-label indications of midodrine, and further large-scale studies are needed to inform and guide its routine use in the ICU 3, 5.