Midodrine cuts recurrent syncope in young, healthy patients

For patients with recurrent vasovagal syncope and no serious comorbid conditions, midodrine can reduce the recurrence of syncope, according to a study published online Aug. 3 in the Annals of Internal Medicine.

Robert Sheldon, M.D., Ph.D., from the University of Calgary in Alberta, Canada, and colleagues examined whether midodrine can prevent vasovagal syncope in a randomized trial involving patients with recurrent vasovagal syncope and no serious comorbid conditions. A total of 133 patients (median age, 32 years; 73 percent female) with a median of six syncope episodes in the previous year were randomly assigned to either placebo or midodrine in a 1:1 ratio.

The researchers found that fewer patients receiving midodrine had at least one syncope episode compared with those receiving placebo (42 versus 61 percent; relative risk, 0.69). The absolute risk reduction was 19 percent and number needed to treat was 5.3. Patients receiving midodrine had a longer time to first syncope (hazard ratio, 0.59). Both groups had similar adverse effects.

“Midodrine is effective in reducing the likelihood of a syncope recurrence in younger patients with frequent syncope when it is administered in conjunction with guideline-directed teaching about lifestyle risk reduction,” the authors write.