midodrine hydrochloride / Generic mfg. - LARVOL DELTA

Successful Use of Midodrine in a Normotensive, Non-cirrhotic Patient With Chylous Ascites Due to Chronic Porto-Mesenteric Thrombosis: A Multidisciplinary Challenge. (PubMed, Cureus) - "Although conventionally reserved for hypotension, midodrine demonstrated therapeutic benefit in a normotensive patient. It may represent a novel adjunct in the management of refractory CA due to portal vein thrombosis, underscoring the importance of a multidisciplinary approach and the need for further research into vasoconstrictor therapy in this setting."

Journal • Cardiovascular • Fibrosis • Gastrointestinal Disorder • Hematological Disorders • Hypertension • Hypotension • Immunology • Infectious Disease • Liver Cirrhosis • Oncology • Pain • Pulmonary Disease • Respiratory Diseases • Thrombosis • Tuberculosis

Progress in the pharmacological management of vasovagal syncope. (PubMed, Expert Rev Clin Pharmacol) - "Atomoxetine is under investigation. Some benefit from fludrocortisone, midodrine, or serotonin-specific reuptake inhibitors. Almost all patients eventually stop fainting, and invasive treatments should be used last and for the very few highly afflicted patients who do not improve with safer measures."

Journal • Review • Hypotension • Psychiatry

A case report of midodrine to treat protein-losing enteropathy for heart transplant candidacy. (PubMed, Eur Heart J Case Rep) - "The development of PLE in patients with Fontan circulations is an indication for cardiac transplantation, but there are often significant barriers due to the many complications. We performed a comprehensive Medline search, and this is the first case demonstrating the use of midodrine to bridge a frail patient with PLE and advanced Fontan heart failure to heart transplantation candidacy and eventual transplant."

Journal • Cardiovascular • Congestive Heart Failure • Heart Failure • Transplantation

Control, Fludrocortisone or Midodrine for the treatment of Orthostatic Hypotension: CONFORM-OH pilot RCT and economic evaluation. (PubMed, Health Technol Assess) - "To answer the research question, novel trial designs are needed. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR127385."

HEOR • Journal • Cardiovascular • Hypotension • Infectious Disease • Movement Disorders • Novel Coronavirus Disease

Prolonged hypotension in children with bilateral kidney absence: a case series and pathophysiologic insights. (PubMed, Pediatr Nephrol) - "Children with bilateral kidney absence can recover from prolonged hypotension; however, this condition is associated with an increased risk of neurologic complications. Careful monitoring and supportive strategies, including approaches reported to be associated with recovery such as Angiotensin II or fluid overload, may help minimize risk."

Journal • CNS Disorders • Genetic Disorders • Glomerulonephritis • Hypotension • Nephrology • Pediatrics • Polycystic Kidney Disease • Renal Disease

Bortezomib Induced Peripheral and Severe Autonomic Neuropathy Characterized By Dizziness, Orthostatic Hypotension and Weight Loss (ASH 2023) - "B was given in combination with lenalidomide and dexamethasone (VRD) but we feel the neuropathic symptoms are more due to B since the combination of just lenalidomide and dexamethasone is not known to cause such complications...13 of 16 received VRD and 3 received Daratumumab, B and dexamethasone-based induction...Nine patients received appetite stimulants; 2 megestrol and 7 dronabinol...11 of the 16 patients had dizziness; 3 patients received fludrocortisone and one received midodrine...Transplantation without resolution of symptoms could possibly worsen the morbidity and delay post-transplant recovery. To the best of our knowledge, we are the first group to report a series of patients with this symptom complex and strongly feel it requires further study in a larger cohort."

Anorexia • Diabetes • Diabetic Neuropathy • Gastrointestinal Disorder • Hematological Malignancies • Hypotension • Metabolic Disorders • Mucositis • Multiple Myeloma • Nephrology • Neuralgia • Oncology • Orthopedics • Pain • Peripheral Neuropathic Pain • Renal Disease

Systematic literature review: treatment of postural orthostatic tachycardia syndrome (POTS). (PubMed, Clin Auton Res) - "For pharmaceuticals, several studies showed significant effects following therapy with ivabradine and β-adrenergic blocking agents. There are single studies which imply that midodrine (hydrochloride) and pyridostigmine seem to have a beneficial effect on hemodynamics in POTS."

Journal • Review • Cardiovascular • CNS Disorders • Fatigue • Hypotension • Infectious Disease

Tension Hydrothorax from Pleuroperitoneal Leak in Peritoneal Dialysis (KIDNEY WEEK 2025) - "Though volume overload is felt more likely than PPL, he is trialed on intermittent hemodialysis (IHD), but severe intradialytic hypotension despite midodrine and IV albumin precludes ultrafiltration...PPL treatment ranges from temporary IHD—with return to PD possible in roughly 50% after 2 months—to invasive options (e.g., pleurodesis, VATS, or thoracotomy). Serial X-ray, obtained (A) hours before restarting PD, (B) immediately after restarting, and (C) after chest tube placement."

Diabetes • Hypotension • Metabolic Disorders • Muscular Dystrophy • Pulmonary Disease • Respiratory Diseases

Intradialytic Hypotension in the Inpatient Setting for Patients on Long-Term Hemodialysis (HD) (KIDNEY WEEK 2025) - "There are comments written by the dialysis nurse and I reviewed to see if the patient had a drop in the BP, if so, if the patient was symptomatic, if dialysis had to be terminated, UF turned off and/or if there was any intervention (eg-Na modeling, administration of midodrine or any return of blood back to patient)...Conclusion In the hospital setting, there is an increased amount of IDH episodes, which can be potentially due to patient’s clinical status, incorrect patient weight, bed scale not working or missing prescriptions. It is important to understand the reason the patient is in the hospital, what their dry weight is, obtaining outpatient records from their dialysis centers and making appropriate changes to the dialysis prescription to help prevent further episodes of intradialytic hypotension."

Clinical • Alzheimer's Disease • Cardiovascular • Cognitive Disorders • Gastrointestinal Disorder • Hypotension • Renal Disease

Autoimmune Autonomic Ganglionopathy in a Patient with Celiac Disease on Dialysis: A Rare Case of Refractory Orthostatic Hypotension (KIDNEY WEEK 2025) - "Despite monitored midodrine therapy, symptoms persisted. There are also strong evidences that novel immunosuppressant agents such as Mycophenolate mofetil and Rituximab may be effective in certain patients who are unresponsive to IVIG or PE. Autoimmune Autonomic Ganglionopathy (AAG) is a rare but potentially treatable cause of OH, requiring a high index of clinical suspicion."

Clinical • Cardiovascular • Celiac Disease • Chronic Kidney Disease • Hypertension • Hypotension • Immunology • Renal Disease

Fractional Excretion of Urinary Sodium and Urinary Sediment Microscopy for Prediction of Early Response to Vasoconstrictors in Hepatorenal Syndrome (KIDNEY WEEK 2025) - "Methods In a prospective observational cohort of AKI in cirrhosis, we searched for patients who met the ICA 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 (Perazella score ≥ 2, i.e.., not HRS)], 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-year period...Conclusion The combination of very low FENa (< 0.18%), absence of overt ATI by uSEDI, and sustained rise in MAP leads to high probability of TR to VC in HRS. Utilizing FENa value and uSEDI findings may facilitate proper patient selection for the use of VC in HRS."

Fibrosis • Hepatology • Immunology • Nephrology • Renal Disease

A Case of Severe Postobstructive Diuresis Requiring Prolonged Inpatient Treatment (KIDNEY WEEK 2025) - "During the 4 th week, fludrocortisone and midodrine were discontinued upon improvement of the polyuria and resolution of the orthostasis. On follow up, a component of free water diuresis was evident, and desmopressin was added with significant decrease in urine output and simultaneous increase in urine osmolarity. This unusual and severe course may be predicted by the chronicity of the obstruction and resulting severity of the kidney insult."

Clinical • Cardiovascular • Hypertension • Hypotension • Metabolic Disorders • Nephrology

Plasma Refill as a Marker of Ultrafiltration Intolerance During Inpatient Hemodialysis (KIDNEY WEEK 2025) - "Stratifying by prescribed ultrafiltration goal, the association of low PRR and IDH was attenuated in patients who previously tolerated more than 2L fluid removal and enhanced in patients with acute kidney failure, history of intolerance to modest ultrafiltration volume (< 2L per session, the median prescribed goal), and midodrine-dependence. Results were similar across different definitions of IDH and times of PRR assessment. Conclusion PRR is a promising marker for hemodynamic stability during HD performed during acute illness and may be a particularly useful adjuvant metric in patients with evidence of ultrafiltration intolerance."

Clinical • Acute Kidney Injury • Hypotension • Nephrology • Renal Disease

Revisiting Precipitating Factors Associated with Hepatorenal Syndrome (KIDNEY WEEK 2025) - "Methods In a prospective observational cohort of AKI in cirrhosis, we searched for patients who met the ICA criteria for HRS, had a urinary sodium < 20 mEq/L, were treated with a vasoconstrictor (VC) [midodrine/octreotide (M/O), norepinephrine (NE) or terlipressin (T)], and achieved a minimum of 5 mmHg of rise in mean arterial pressure, over a 7-year period...Conclusion Refractory ascites is the most common precipitating factor preceding AKI due to HRS, likely reflecting a progressive state of worsening portal hypertension, followed by ACLF / new-onset jaundice. Severe hyponatremia may be considered as a novel independent factor associated with the development of HRS, whereas SBP may not be as common trigger as previously reported."

Acute Kidney Injury • Addiction (Opioid and Alcohol) • Cardiovascular • CNS Disorders • Fibrosis • Gastroenterology • Heart Failure • Hematological Disorders • Hepatic Encephalopathy • Hepatology • Immunology • Infectious Disease • Inflammation • Liver Failure • Nephrology • Portal Hypertension • Renal Disease • Thrombosis

Early Relapse of Hepatorenal Syndrome (KIDNEY WEEK 2025) - "Methods In a prospective observational cohort of AKI in cirrhosis, we searched for patients who met the ICA criteria for HRS, had a urinary sodium < 20 mEq/L, were treated with a VC [midodrine/octreotide (M/O), norepinephrine (NE) or terlipressin (T)], and achieved a minimum of 5 mmHg of rise in mean arterial pressure, over a 7-year period...Conclusion 30-day relps-HRS is common and associated with higher MELD score. This observation highlights the need for implementation of a durable VC therapy in HRS-AKI for those at high risk of relps-HRS."

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

Midodrine Use in Patients with ESKD on Hemodialysis (HD) (KIDNEY WEEK 2025) - "Prospective studies are needed to confirm this. Early identification of decline may support timelier palliative care engagement."

Clinical • Cardiovascular • Congestive Heart Failure • Coronary Artery Disease • Diabetes • Heart Failure • Hypertension • Hypotension • Metabolic Disorders • Palliative care • Peripheral Arterial Disease • Renal Disease

AKI and Hepatorenal Syndrome: Diagnosis, Management, and Treatment (KIDNEY WEEK 2025) - "Several interventions for kidney dysfunction in cirrhosis have been explored, including volume expansion with albumin and vasoconstrictors, such as midodrine, octreotide, norepinephrine, and, more recently, terlipressin...Support is provided by an educational grant from Mallinckrodt Pharmaceuticals. Learning Objective(s) Describe the pathophysiology of HRS-AKI Discuss etiologies, mechanisms, and workup of HRS-AKI Explain management and treatment strategies for HRS-AKI"

Fibrosis • Hepatology • Immunology • Nephrology • Renal Disease

Combining random forest and XGBoost models for source apportionment and health risk assessments of heavy metals in suburban farmland soils. (PubMed, Ecotoxicol Environ Saf) - "To explore the environmental risks in farmlands, three typical heavy metals (Hg, Pb and Cd) in 232 surface soil samples (0-20 cm) from representative farmland areas in Midong District, Urumqi city, Xinjiang, were comprehensively investigated...Combining the random forest and XGBoost models, the following three heavy metal sources were determined through principal component analysis: F1 (anthropogenic activities), F2 (industrial activities), and F3 (long-term phosphorus fertilizer use). Overall, this study emphasized the importance of monitoring heavy metal pollution in farmland soil, providing a sound basis for effectively managing heavy metal pollution in farmland soil and ensuring farmland soil quality maintenance."

Journal • Oncology

A Rare Case of Overlapping Severe Cutaneous Adverse Reactions (ACAAI 2025) - "Although other new medications included midodrine and amiodarone, these were stopped prior to admission. Vancomycin is an uncommon culprit for both AGEP and DRESS. Detailed history and broad differential are crucial for evaluation of drug eruptions to guide appropriate management and follow up."

Clinical • Eosinophilia • Immunology

Identifying and Managing Anaphylaxis During Hemodialysis (ACAAI 2025) - "Patient A experienced recurrent hypotension during dialysis refractory to albumin, midodrine, dialysis without ultrafiltration, and premedication with a corticosteroid, antihistamine and H2 blocker...Patient B tolerated HD with the cellulose membrane, cetirizine and famotidine premedication, and priming the tubing with 2L NS due to continued ethylene oxide exposure from the tubing. Discussion Rising numbers of patients on HD makes recognition and management of hypersensitivity reactions crucial, particularly in resource-limited situations. Though medications are the most common cause of severe reactions, providers should consider dialyzer membranes, which are associated with pseudoallergic reactions, and the sterilizing agent ethylene oxide, which is a known trigger of anaphylaxis."

Chronic Kidney Disease • Dermatology • Hematological Malignancies • Hypotension • Immunology • Multiple Myeloma • Renal Disease • Urticaria

Integrative analysis of MoTrPAC and LINCS transcriptomes identifies cardiovascular-relevant exercise-mimetic drugs (AHA 2025) - "Among top hits, midodrine, an α1-adrenergic agonist investigating for its cardioprotective properties, matched 24h post-exercise signatures in both species and activated TFs linked to mitochondrial function, vascular remodeling, and metabolism (FOXP1, CREB1). PD-0325901, a MEK inhibitor, showed strong similarity to early phases (15–45 min), inducing early-response TFs (FOS, HIF1A, RELA), and reflected endurance training upregulation of oxidative phosphorylation...This integrative analysis identifies candidate compounds that mimic distinct phases of exercise-induced molecular remodeling. Ongoing validation in cardiac models aims to translate these findings into cardiovascular contexts."

Cardiovascular • CREB1 • FOXP1 • HIF1A • RELA

Terlipressin Is Associated With Decreased Renal Replacement Therapy Compared With Midodrine/Octreotide Among Patients With Hepatorenal Syndrome (ACG 2025) - "10,832 MO and 151 T patients with a diagnosis of HRS-AKI within 1 day of treatment were identified. The mean ages for the MO and T groups were 55.4 and 55.6 years, respectively. 58.1% of the MO group and 63.6% of the T group were male, and 73.1% of the MO group and 74.8% of the T group were white."

Clinical • Acute Kidney Injury • Cardiovascular • CNS Disorders • Congestive Heart Failure • Heart Failure • Hematological Disorders • Hepatic Encephalopathy • Hepatology • Nephrology • Portal Hypertension • Renal Disease

Recurrent Ischemic Colitis Secondary to Orthostatic Hypotension: Recognizing a Hidden Culprit (ACG 2025) - "Given the recurrent ischemic colitis episodes and persistently low blood pressure, her gastroenterologist suspected orthostatic hypotension as a contributing factor.She was ultimately diagnosed with orthostatic hypotension and started on midodrine, along with lifestyle modifications including increased salt and fluid intake and the use of compression garments. This case underscores orthostatic hypotension as a rare but important cause of recurrent ischemic colitis...Recognizing orthostatic hypotension as the primary etiology enabled targeted treatment and may help prevent recurrence. Clinicians should consider it in patients with recurrent ischemic colitis and no clear acute trigger.Figure: Figure 1: Endoscopic images showing ischemic colitis in the descending colon (left) and sigmoid colon (right).Figure: Figure 2: Endoscopic image showing ischemic colitis in the descending colon six months after discharge, indicated by the yellow arrowhead."

Cardiovascular • Dermatology • Gastroenterology • Gastrointestinal Disorder • Hypotension • Immunology

Testicular Ischemia Following Terlipressin Use for Hepatorenal Syndrome (ACG 2025) - "After treating his HRS with albumin, midodrine, and octreotide, his MAPs remained below goal and his kidney function continued to worsen...Genital ischemia is a rarely reported complication, likely because the scrotum is well-vascularized. This case highlights the importance of investigating all signs of possible ischemia in patients on terlipressin, including testicular pain.Figure: A 70-yo M with newly diagnosed cirrhosis developed testicular ischemia without signs of necrosis following terlipressin administration for hepatorenal syndrome."

Acute Kidney Injury • Addiction (Opioid and Alcohol) • Cardiovascular • Fibrosis • Heart Failure • Hepatology • Immunology • Nephrology • Portal Hypertension • Renal Disease • Respiratory Diseases • Urology

Hepatic Hydrothorax in the Setting of Small Volume Ascites (ACG 2025) - "After risk benefit discussions with the patient, it was decided to increase diuretics and midodrine doses to treat recurrent HH and to complete thoracentesis outpatient as needed. Hepatic hydrothorax is an infrequent complication of cirrhosis and portal hypertension...Treatment involves uptitration of diuretics, thoracentesis, Pleurx catheter, and/or TIPS. In patients with little to no ascites, clinical suspicion is imperative for diagnosis so treatment can be initiated promptly."

Autoimmune Hepatitis • Cardiovascular • Fibrosis • Gastroenterology • Gastroesophageal Reflux Disease • Hepatology • Immunology • Infectious Disease • Inflammation • Inflammatory Arthritis • Liver Cirrhosis • Pneumonia • Portal Hypertension • Primary Biliary Cholangitis • Pulmonary Embolism • Respiratory Diseases • Rheumatoid Arthritis • Rheumatology