Wednesday, March 30, 2016

Oral vasopressor (Midodrine)

PulmCrit - March 28, 2016 by Josh Farkas
"Midodrine is an oral agent which functions as an alpha-1 agonist. It has been used in a variety of situations including autonomic dysfunction, hepatorenal syndrome, and dialysis-induced hypotension. Over the past few years there has been increasing interest in using midodrine to facilitate weaning off vasopressors.

  • Some patients recovering from septic shock develop a state of persistent vasodilation (“vasoplegia”) which may take a few days to resolve. This delays discharge from ICU due to a persistent requirement for low-dose intravenous vasopressors.
  • Midodrine is an oral alpha-1 agonist, with the same mechanism of action as phenylephrine. It is a fairly safe drug which has been used among outpatients for decades.
  • Several reports support the use of midodrine to facilitate weaning off intravenous vasopressors in appropriately selected patients with careful monitoring. This may reduce ICU length of stay, avoiding ICU complications (e.g. central line infection and delirium)."