Midodrine

 Q: Midodrine causes? (select one)

A) arterial constriction 

B) venous constriction 

C) arterial and venous constrictions

Answer: C

Midodrine is an alpha agonist which causes both arterial and venous constrictions. It has many properties which makes it a desirable drug to use in ICU as an adjuvant treatment for refractory hypotension. Midodrine has no direct effect on heart rate and is rapidly absorbed from the GI tract. It reaches a peak plasma concentration in about 30 minutes and does not cross the blood-brain barrier. 

Dose should not exceed above 40 mg/day.

#hemodynamics

#pharmacology

References:

1. Rizvi MS, Trivedi V, Nasim F, Lin E, Kashyap R, Andrijasevic N, Gajic O. Trends in Use of Midodrine in the ICU: A Single-Center Retrospective Case Series. Crit Care Med. 2018 Jul;46(7):e628-e633. doi: 10.1097/CCM.0000000000003121. PMID: 29613861.

2. Anstey MH, Wibrow B, Thevathasan T, et al. Midodrine as adjunctive support for treatment of refractory hypotension in the intensive care unit: a multicenter, randomized, placebo controlled trial (the MIDAS trial). BMC Anesthesiol. 2017;17(1):47. Published 2017 Mar 21. doi:10.1186/s12871-017-0339-x

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. 

4. 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.