The effects of midodrine on the natriuretic response to furosemide in cirrhotics with ascites
Article first published online: 4 AUG 2010
© 2010 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 32, Issue 8, pages 1044–1050, October 2010
How to Cite
Misra, V. L., Vuppalanchi, R., Jones, D., Hamman, M., Kwo, P. Y., Kahi, C. and Chalasani, N. (2010), The effects of midodrine on the natriuretic response to furosemide in cirrhotics with ascites. Alimentary Pharmacology & Therapeutics, 32: 1044–1050. doi: 10.1111/j.1365-2036.2010.04426.x
- Issue published online: 4 AUG 2010
- Article first published online: 4 AUG 2010
- Publication data Submitted 10 February 2010 First decision 10 March 2010 Resubmitted 14 July 2010 Accepted 16 July 2010
Aliment Pharmacol Ther 2010; 32: 1044–1050
Background Resistance to loop diuretics is common in patients with ascites. Diminished glomerular filtration rate (GFR) is thought to mediate resistance to loop diuretics. Midodrine, a commonly used alpha-1 agonist, has been shown to improve GFR in non-azotemic patients with cirrhosis.
Aim To conduct a randomized, double-blind, placebo-controlled, cross-over study to test the hypothesis that midodrine significantly increases natriuretic response of IV furosemide in non-azotemic cirrhotics with ascites.
Methods All subjects participated in both phases, which were (i) furosemide IV infusion + oral midodrine 15 mg administered 30 min before furosemide (ii) furosemide IV infusion + oral placebo administered 30 min before furosemide. Primary outcomes were 6-h urine sodium excretion and 6-h total urine volume.
Results A total of 15 patients (men: 8; age: 52.7 ± 7.6 years; serum creatinine: 1.06 ± 0.2 mg/dL) were studied. Total 6-h urine sodium excretion was 109 ± 42 mmol in the furosemide + midodrine treatment phase and was not significantly different from that in the furosemide + placebo treatment phase (126 ± 69 mmol, P = 0.6). Similarly, mean 6-h total urine volume was not significantly different between two groups (1770 ± 262 mL vs. 1962 ± 170 mL, P = 0.25).
Conclusions Oral midodrine does not increase the natriuretic response to furosemide in non-azotemic cirrhotic patients with ascites. Orally administered midodrine does not increase natriuretic response to furosemide in non-azotemic cirrhotic patients with ascites.