Monday, March 12, 2018

Oral Vasopressor

Q: Out of the following which drug is known as oral pressor?

A) Hydrocortisone
B) Midodrine
C) Octreotide
D) Clonidine
E) Methylene Blue


Midodrine is an alpha1-agonist. Active metabolite of midodrine is desglymidodrine. It activates  alpha-adrenergic receptors of the arteriolar and venous vasculature, resulting in increase in vascular tone. It is an extremely useful drug to use in renal and hepatic patients who frequently require longer ICU stay due to baseline hypotension.

Hydrocortisone is useful only in adrenal insufficiency related hypotension.

Octreotide has been used in conjunction with midodrine for  hypotension in diuretic resistant ascites in cirrhotic patients but has no role standing alone.

Clonidine is an anti-hypertensive.

Methylene blue has been used with success in resistant vasoplegia but it is not available in oral form.



1. Kaufmann H, Brannan T, Krakoff L, et al. Treatment of orthostatic hypotension due to autonomic failure with a peripheral alpha-adrenergic agonist (midodrine). Neurology 1988; 38:951. 

2. Low PA, Gilden JL, Freeman R, et al. Efficacy of midodrine vs placebo in neurogenic orthostatic hypotension. A randomized, double-blind multicenter study. Midodrine Study Group. JAMA 1997; 277:1046. 

3. Parsaik AK, Singh B, Altayar O, et al. Midodrine for orthostatic hypotension: a systematic review and meta-analysis of clinical trials. J Gen Intern Med 2013; 28:1496.

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