Usefulness of midodrine in patients with severely symptomatic neurocardiogenic syncope: a randomized control study

J Cardiovasc Electrophysiol. 2001 Aug;12(8):935-8. doi: 10.1046/j.1540-8167.2001.00935.x.


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.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adrenergic alpha-Agonists / therapeutic use*
  • Adult
  • Dose-Response Relationship, Drug
  • Female
  • Follow-Up Studies
  • Humans
  • Kentucky
  • Male
  • Middle Aged
  • Midodrine / therapeutic use*
  • Prospective Studies
  • Quality of Life / psychology
  • Recurrence
  • Severity of Illness Index
  • Surveys and Questionnaires
  • Syncope, Vasovagal / drug therapy*
  • Treatment Outcome
  • Wisconsin


  • Adrenergic alpha-Agonists
  • Midodrine