midodrine hydrochloride / Generic mfg. - LARVOL DELTA

PREDICTION OF RESPONSE TO VASOCONSTRICTORS IN HEPATORENAL SYNDROME WITH FRACTIONAL EXCRETION OF URINARY SODIUM AND URINARY SEDIMENT MICROSCOPY (ISN-WCN 2026) - "We hypothesized that utilizing fractional excretion of urinary sodium (FENa) (as functional biomarker) and/or evidence of acute tubular insult (ATI) by urinary sediment microscopy (uSEDI) (as injury biomarker) may allow predicting TR to VC in HRS-AKI.Methods In a prospective observational cohort of AKI in cirrhosis, we searched for patients who met criteria for HRS and: 1) had a FENa < 1%, 2) did not have ≥ 6 "muddy brown" granular casts (MBGC) per low power field (lpf) by uSEDI [deemed overt ATI)], 3) were treated with a VC [midodrine/octreotide (M/O), norepinephrine (NE) or terlipressin (T)], and 4) achieved ≥ 5 mmHg rise in mean arterial pressure (MAP); over a 7.5-year period...When restricting the analysis to MAP rise ≥ 15 mmHg (n=37), the AUROC for combining FENa and uSEDI ATI score to predict TR improved to 0.91 (p=0.006).Conclusion The combination of very low FENa (< 0.20%), absence of overt ATI by uSEDI, and sustained rise in MAP leads to high..."

Acute Kidney Injury • Fibrosis • Hepatology • Immunology • Nephrology • Renal Disease

Effect of Midodrine on Short Term Mortality and Liver Function in Patients with Cirrhosis and Ascites: A Systematic Review and Meta-analysis (APASL 2026) - No abstract available

Retrospective data • Review • Fibrosis • Hepatology • Immunology

Midodrine with albumin improves ascites control in Acute-on-chronic liver failure: A Double Bind Randomized trial (MIDAS trial) (APASL 2026) - No abstract available

Clinical • Hepatology • Liver Failure

Midodrine with albumin improves ascites control in acute-on-chronic liver failure: a randomized trial (MIDAS trial) (EASL 2026) - No abstract available

Clinical • Hepatology • Liver Failure

Safety & Clinical Use of Droxidopa for Midodrine Augmentation in Vasopressor Weaning in Septic Shock (SCCM 2026) - "Droxidopa augmentation of midodrine for vasopressor weaning in septic shock appears feasible, as it was well tolerated and most patients were successfully weaned off IV vasopressors. Further studies are needed to evaluate the long-term impact of dual therapy on ICU lengths of stay and outcomes in patients requiring extended hospitalization."

Clinical • Cardiovascular • CNS Disorders • Hypotension • Infectious Disease • Septic Shock

Midodrine for Vasopressor Weaning in Septic Shock Patients on Moderate to High-Dose Vasopressors (SCCM 2026) - "Adjunctive midodrine in patients with SS on MH dose vasopressors was associated with longer vasopressor duration and longer LOS. These findings suggest caution in using midodrine in patients with SS until further evidence is available."

Clinical • Cardiovascular • Heart Failure • Hypotension • Nephrology • Renal Disease • Septic Shock

Evaluating Dosing of Midodrine for Acceleration of Weaning Norepinephrine in the Intensive Care Unit (SCCM 2026) - "This is the first study to compare dosing strategies of midodrine for norepinephrine weaning. The primary endpoint showed no statistically significant difference between high-and low-dose groups. A notable proportion of patients were discharged on midodrine, and bradycardia was a common adverse event."

Cardiovascular • Critical care

Effect of Terlipressin Versus Octreotide/Midodrine on Mortality in Patients With HRS (SCCM 2026) - "Terlipressin appears to have efficacy in improving renal function and mortality n patients with HRS when compared to the current regimen of MO. Additional larger studies would be needed to confirm the efficacy of terlipresin in improving renal function and reversing HRS."

Clinical • Acute Kidney Injury • Fibrosis • Hepatology • Immunology • Nephrology • Renal Disease

Midodrine Utilization After Medical Intensive Care Unit Initiation (SCCM 2026) - "Overall, patients were infrequently discharged on midodrine after ICU initiation, their mortality was in line with their SOFA score estimate, and they often necessitated a higher level of care at discharge."

Cardiovascular • Critical care • Hypotension

Terbutaline for Spinal Cord Injury-Induced Bradycardia (SCCM 2026) - "Pseudoephedrine was switched to midodrine due to issues with hypotension, but after a bradycardia event, theophylline was added and titrated up to 100 mg Q8H and midodrine was removed...Ultimately the patient developed acute renal failure requiring dialysis and the family decided to transition to comfort measures. Bradycardia secondary to SCI can be difficult to manage. We describe two experiences of relative benefit with the use of oral terbutaline."

Acute Kidney Injury • Cardiovascular • CNS Disorders • Hypotension • Musculoskeletal Diseases • Orthopedics • Renal Disease

Midodrine for the Prevention of Escalation of Care in Septic Patients (SCCM 2026) - "There were no patient factors identified that contributed to escalation of care. Non-ICU septic patients who received midodrine for blood pressure support, were less likely to receive guideline directed fluid resuscitation, and had a higher mortality rate compared to overall study site sepsis mortality. Additional studies are needed to determine midodrine's role in sepsis resuscitation."

Clinical • Infectious Disease • Septic Shock

Acute Kidney Dysfunction in Cirrhosis: Diagnosis, Drugs, and Dialysis (SCCM 2026) - "The numerous available interventions (albumin, octreotide, midodrine, norepinephrine, terlipressin) will be discussed, with a focus on which drug to choose for which patient and practical considerations such as dosing, formulary, access, and transitions of care. The choice of introducing dialysis with reconciliation of prognosis, transplant candidacy, and modality options will also be discussed.Learning Objectives: • Differentiate causes of acute kidney dysfunction in patients with cirrhosis using contemporary criteria, tools, and technology • Outline clinical and practical considerations for medication selection in patients with acute kidney dysfunction in cirrhosis • Discuss key considerations for selecting patients with cirrhosis for dialysis and optimal dialysis prescription Learning Objectives: • Differentiate causes of acute kidney dysfunction in patients with cirrhosis using contemporary criteria, tools, and technology • Outline clinical and practical..."

Acute Kidney Injury • Cognitive Disorders • Fibrosis • Hepatology • Immunology • Liver Failure • Nephrology • Renal Disease

Droxidopa for Facilitating Vasopressor Weaning in Persistent Hypotension (SCCM 2026) - "Midodrine is the most widely studied oral agent but has limited efficacy in decreasing vasopressor duration. In this retrospective analysis, initiation of droxidopa led to vasopressors discontinuation by day 7 in a small proportion of patients. Though droxidopa was well tolerated, larger comparative trials are warranted to elucidate its potential role in vasopressor weaning strategies."

Hypotension

TAKOTSUBO CARDIOMYOPATHY WITH DYNAMIC LEFT VENTRICULAR OUTFLOW TRACT OBSTRUCTION PRESENTING AS STEMI TRIGGERED BY DUCK FLOWER DETOX (ACC 2026) - "Angiography showed reversible coronary vasospasm relieved by nitroglycerin and verapamil...Hypotension was managed with fluids and midodrine; inotropes were avoided... This first reported case of Takotsubo cardiomyopathy from a "duck flower" cleanse highlights the risk of unregulated herbal products and the need to avoid inotropes in dynamic obstruction."

Acute Coronary Syndrome • Cardiomyopathy • Cardiovascular • Congestive Heart Failure • Heart Failure • Hypotension • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases • Vascular Neurology

A CASE OF DELAYED SEVERE HYPOTENSION AND BRADYCARDIA POST-RENAL DENERVATION (ACC 2026) - "Case: A middle-aged female with refractory hypertension and history of rheumatoid arthritis on hydroxychloroquine and muscle spasms treated with tizanidine underwent RDN...Her bradycardia and hypotension recurred despite midodrine, theophylline and fludrocortisone initiation, ultimately necessitating permanent pacemaker implantation... This case highlights a rare, delayed presentation of severe hypotension and bradycardia after RDN, reflecting autonomic imbalance. Initially, she improved with management of reversible factors, but persistent bradycardia despite medical therapy required PPM placement. While reversible causes should be addressed first, permanent pacing may be required in such refractory cases."

Clinical • Cardiovascular • CNS Disorders • Hypertension • Hypotension • Immunology • Inflammatory Arthritis • Rheumatoid Arthritis

OUT OF SYNC: A PACED RHYTHM THAT COULDN'T PREVENT RECURRENT SYNCOPE IN A PATIENT WITH MIXED CAROTID SINUS SYNDROME (ACC 2026) - "Midodrine was initiated with full resolution while awaiting radiation therapy... Structural causes of CSS should be considered in head and neck malignancy. Mixed type cases may require integrated device and medical therapy."

CAR T-Cell Therapy • Clinical • Cardiovascular • Head and Neck Cancer • Hypotension • Musculoskeletal Pain

WHEN LYING HURTS: SUPINE HYPERTENSION WITH ORTHOSTATIC HYPOTENSION IN A MISDIAGNOSED CASE OF POTS (ACC 2026) - "Patient was advised to elevate the head of the bed ≥45°, use compression garments, and midodrine during the day. Clonidine was started at night to help with SH. Improvement was noted in SH from his charted readings."

Clinical • Cardiovascular • Chronic Kidney Disease • CNS Disorders • Hypertension • Hypotension • Nephrology • Pulmonary Disease • Renal Disease

RATES OF CICU AND MICU ADMISSION AND IN-HOSPITAL MORTALITY AMONG PATIENTS REQUIRING ORAL PRESSORS AND RAPID RESPONSE TEAM ACTIVATION WITHIN 24 HOURS OF ADMISSION (ACC 2026) - "Background: It is unclear if oral pressors like droxidopa and midodrine prevent cardiac and medical intensive care unit (CICU, MICU) admission after rapid response team (RRT) activation within 24 hours of hospital admission. Oral pressor use in patients with RRT within 24 hours of admission was associated with greater comorbidities, illness severity, and CICU/MICU consults. Similar CICU/MICU admission rates and greater IV pressor requirements after correcting for blood pressure suggests oral pressors do not prevent ICU admission and could delay needed escalation."

Clinical • Cardiovascular • Congestive Heart Failure • Heart Failure

THE ELABORATE SCHEME OF EISENMENGER SYNDROME (ACC 2026) - "She was managed with airway clearance, chest physiotherapy, and started on sildenafil and midodrine. With increasing survival of CHD patients into adulthood, early recognition and treatment of PAH and its complication remain essential."

Atrial Fibrillation • Cardiovascular • Heart Failure • Metabolic Disorders • Pulmonary Arterial Hypertension • Respiratory Diseases

CARDIONEURAL ABLATION THERAPY FOR INSPIRATORY-MEDIATED BRADYCARDIA AND SYNCOPE: A NOVEL PATHOLOGY AND THERAPEUTIC APPROACH (ACC 2026) - "Medical therapies including midodrine, glycopyrrolate, and respiratory modification techniques proved ineffective... CNA achieved complete symptom resolution with >25% increase in resting heart rate. At 6-month follow-up, inspiratory bradycardia was no longer reproducible and functional capacity dramatically improved. CNA represents a promising therapeutic option for refractory autonomically-mediated syncope with mixed pathophysiology."

Cardiovascular • Hypotension

REAL-WORLD COMPARATIVE OUTCOMES OF DROXIDOPA VS MIDODRINE IN OLDER ADULTS WITH ORTHOSTATIC HYPOTENSION (ACC 2026) - "In a large cohort of patients aged ≥65 years, droxidopa led to fewer acute care visits than midodrine with similar survival rates. This suggests droxidopa may lower expensive, high-acuity encounters without affecting survival or increasing side effects. Key limitations include the retrospective design and lack of data on supine hypertension."

Clinical • Real-world • Real-world evidence • CNS Disorders • Congestive Heart Failure • Diabetes • Heart Failure • Hypertension • Hypotension • Metabolic Disorders • Movement Disorders • Parkinson's Disease

CARDIOGENIC SHOCK MANAGEMENT WITH VA-ECMO IN CONGENITALLY CORRECTED TRANSPOSITION OF THE GREAT ARTERIES (ACC 2026) - "Case: A 41-year-old man with L-TGA, LVOT obstruction and subpulmonic stenosis requiring left ventricle to pulmonary artery (LV-PA) conduit presented to outside hospital with subacute HF - precipitated by recent metoprolol and midodrine initiation... In L-TGA with prior repair, proactive multidisciplinary planning and tailored mechanical support are critical to treat dual-ventricle physiology with anatomic obstructions."

Cardiovascular • Congestive Heart Failure • Heart Failure • Respiratory Diseases

Unraveling the clinical heterogeneity of NELL1-positive membranous nephropathy: A case report of an idiopathic presentation (UKKW 2026) - "He struggled significantly with postural hypotension, requiring treatment with midodrine. Due to persistence of heavy proteinuria, decline in renal function (eGFR-44ml/min/1.73m2, creatinine-130umol/L in December 2025) and frailty, immune suppression with Rituximab was offered... We present a case of NELL1-MN without secondary associations, contributing to the expanding clinical spectrum of this entity. Recognition of both high-risk (eg: malignancy/ drug-associated) and potentially lower-risk idiopathic phenotypes should support clinical practice. Larger prospective studies are needed to clarify pathogenesis, define risk stratification and optimise treatment strategies of this evolving condition."

Case report • Clinical • Heterogeneity • Atrial Fibrillation • Bronchiectasis • Cardiovascular • Congestive Heart Failure • Glomerulonephritis • Heart Failure • Hematological Malignancies • Hepatology • Human Immunodeficiency Virus • Hypotension • Immunology • Infectious Disease • Multiple Myeloma • Nephrology • Pulmonary Disease • Renal Disease • Respiratory Diseases • NELL1

The Effects of Sertraline on Dialysis-Induced Hypotension: A Systematic Review and Meta-Analysis. (PubMed, Healthcare (Basel)) - " Sertraline significantly improves hemodynamic stability during hemodialysis with a favorable safety profile. It represents a promising option for DIH, particularly in patients with comorbid depression or contraindications to midodrine."

Journal • Retrospective data • Review • Chronic Kidney Disease • CNS Disorders • Depression • Hypotension • Nephrology • Psychiatry • Renal Disease

Carvedilol and Midodrine Versus Carvedilol Alone in Preventing Early Rebleed in Patients With Cirrhosis. (clinicaltrials.gov) - P=N/A | N=210 | Not yet recruiting | Sponsor: Institute of Liver and Biliary Sciences, India

New trial • Fibrosis • Gastroenterology • Hepatology • Immunology • Liver Cirrhosis