Journal of General Internal Medicine

, Volume 28, Issue 11, pp 1496–1503 | Cite as

Midodrine for Orthostatic Hypotension: A Systematic Review and Meta-Analysis of Clinical Trials

  • Ajay K. Parsaik
  • Balwinder Singh
  • Osama Altayar
  • Soniya S. Mascarenhas
  • Shannon K. Singh
  • Patricia J. Erwin
  • M. Hassan Murad
Review Article



To perform a systematic review and meta-analysis of clinical trials evaluating the efficacy and safety of midodrine in orthostatic hypotension (OH).


We searched major databases and related conference proceedings through June 30, 2012. Two reviewers independently selected studies and extracted data. Random-effects meta-analysis was used to pool the outcome measures across studies.


Seven trials were included in the efficacy analysis (enrolling 325 patients, mean age 53 years) and two additional trials were included in the safety analysis. Compared to placebo, the mean change in systolic blood pressure was 4.9 mmHg (p = 0.65) and the mean change in mean arterial pressure from supine to standing was −1.7 mmHg (p = 0.45). The change in standing systolic blood pressure before and after giving midodrine was 21.5 mmHg (p < 0.001). A significant improvement was seen in patients’ and investigators’ global assessment symptoms scale (a mean difference of 0.70 [95 % CI 0.30–1.09; p < 0.001] and 0.80 [95 % CI 0.76–0.85; p < 0.001], respectively). There was a significant increase in risk of piloerection, scalp pruritis, urinary hesitancy/retention, supine hypertension and scalp paresthesia after giving midodrine. The quality of evidence was limited by imprecision, heterogeneity and increased risk of bias.


There is insufficient and low quality evidence to support the use of midodrine for OH.


orthostatic hypotension midodrine systematic review meta-analysis efficacy safety 



We would like to thank Dr. Christian Jeng-Singh (Mayo Clinic, Rochester, MN) for his help in the translation of the German articles.

Conflict of Interest

The authors declare that they do not have a conflict of interest.



Supplementary material

11606_2013_2520_MOESM1_ESM.pdf (71 kb)
Online Appendix (PDF 71 kb)


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Copyright information

© Society of General Internal Medicine 2013

Authors and Affiliations

  • Ajay K. Parsaik
    • 1
  • Balwinder Singh
    • 1
  • Osama Altayar
    • 2
    • 5
  • Soniya S. Mascarenhas
    • 3
  • Shannon K. Singh
    • 4
  • Patricia J. Erwin
    • 2
  • M. Hassan Murad
    • 2
    • 5
  1. 1.Department of NeurologyMayo ClinicRochesterUSA
  2. 2.Knowledge and Evaluation ResearchMayo ClinicRochesterUSA
  3. 3.Health Care ManagementLondon Training CollegeLondonUK
  4. 4.Department of General SurgeryMayo ClinicRochesterUSA
  5. 5.Division of Preventive MedicineMayo ClinicRochesterUSA

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