Is midodrine an effective adjuvant therapy in septic shock management?

Midodrine as an adjuvant therapy in septic shock can reduce the need for IV norepinephrine, potentially improving hemodynamic stability. However, midodrine didn’t significantly shorten the duration of vasopressor use or hospital stay.

Study details: This open-label randomized controlled trial evaluated the efficacy of midodrine as an adjuvant therapy in 100 patients with septic shock. Participants were randomized to receive either IV norepinephrine alone (control group) or IV norepinephrine plus oral midodrine 10 mg every 8 hours (midodrine group). The primary outcome was 28-day in-hospital mortality. Secondary outcomes included 7-day ICU mortality, average dose, and duration of IV norepinephrine, ICU length of stay (LOS), and in-hospital LOS.

Results: The 28-day mortality rate was 68% in the control group vs. 54% in the midodrine group (risk difference -14%; 95% confidence interval [CI] -32.9% to 4.9%). The 7-day ICU mortality rate was 56% in the control group vs. 42% in the midodrine group (risk difference -14%; 95% CI -33.4% to 5.4%). The average IV norepinephrine dose was significantly lower in the midodrine group (mean difference 0.06; 95% CI 0.01-0.11; p=0.002). However, midodrine didn’t significantly impact the duration of IV norepinephrine use, ICU LOS, or in-hospital LOS.

Source:

El-Nagdy NK, et al. (2025, April 16). Pharmacotherapy. Efficacy of adjuvant use of midodrine in patients with septic shock: An open label randomized controlled trial. https://pubmed.ncbi.nlm.nih.gov/40241385/