Midodrine efficacy and pharmacokinetics in a patient with recurrent intradialytic hypotension

Douglas L. Blowey, J. Williamson Balfe, Indra Gupta, Mukesh M. Gajaria, Gideon Koren

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31 Scopus citations


Recurrent intradialytic hypotension, a complication of hemodialysis, is a consequence of an inadequate compensatory response or a paradoxic response to ultrafiltration-induced volume reduction. We report the use of midodrine, an alpha agonist, in an 18-year-old man with Bardet-Biedl syndrome and recurrent intradialytic hypotension. The clinical features of the intradialytic hypotensive spells are consistent with a paradoxic withdrawal of sympathetic activity, although an underlying abnormality in autonomic dysfunction cannot be excluded. Midodrine significantly increased the intradialytic blood pressure and decreased the intradialytic hypotensive episodes requiring intervention. The pharmacokinetic characteristics of the prodrug midodrine and the active metabolite deglymidodrina in this patient with end-stage renal disease approximate those reported for patients with normal renal function. However, the prolonged terminal half-life for the active metabolite, de-glymidodrine, warrants careful administration in patients with renal failure.

Original languageEnglish
Pages (from-to)132-136
Number of pages5
JournalAmerican Journal of Kidney Diseases
Issue number1
StatePublished - Jul 1996
Externally publishedYes


  • Hemodialysis
  • de-glymidodrine
  • hypotension
  • midodrine
  • pharmacokinetics
  • α- agonist


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