Usefulness of Midodrine in Patients with Severely Symptomatic Neurocardiogenic Syncope: A Randomized Control Study

Midodrine for Neurocardiogenic Syncope. Introduction: The efficacy of midodrine for the management of patients with neurocardiogenic syncope was assessed prospectively in a randomized control study. Methods and Results: Patients who had at least monthly occurrences of syncope and a positive tilt‐table test were included in the study. A total of 61 patients were randomly allocated to treatment either with midodrine or with fluid, salt tablets, and counseling. Midodrine was given at a starting dose of 5 mg three times a day and increased up to a dose of 15 mg three times a day when required. Midodrine was given during the daytime every 6 hours. Thirty‐one patients were assigned to treatment with midodrine; the other 30 patients were advised to increase their fluid intake and were instructed to recognize their prodromes and abort the progression to syncope. Patients were followed‐up for at least 6 months. A quality‐of‐life questionnaire was administered at the time of randomization and 6 months after. At the 6‐month follow‐up, 25 (81%) of 31 midodrine‐treated patients and 4 (13%) of the 30 fluid‐therapy patients had remained asymptomatic ( P < 0.001 ). One patient had to discontinue taking midodrine due to severe side effects and another six patients experienced minor side effects that did not require drug discontinuation. Conclusion: Midodrine appeared to provide a significant benefit in patients with neurocardiogenic syncope. To prevent recurrence of symptoms, dose adjustments were required in about one third of patients.