Background:Clonidine is a centrally acting a2 adrenergic and imidazoline-1 receptor agonist that can cause somnolence,bradycardia,and hypotension within several hours of ingestion.Less well-described but observed by u...Background:Clonidine is a centrally acting a2 adrenergic and imidazoline-1 receptor agonist that can cause somnolence,bradycardia,and hypotension within several hours of ingestion.Less well-described but observed by us locally is the observation that patients presenting after large overdoses including clonidine can have prolonged autonomic instability.As a result,they may require many days in hospital before recovery.We have previously used midodrine as an indirect antagonist with good effect;however,there are no previous reports of its use for this indication.Case presentation:We present the case of a young female patient who developed prolonged autonomic instability following a large overdose of clonidine(coingested with smaller doses of escitalopram+lisdexamfetamine)that was treated with midodrine but complicated by a type 2 non-ST segment elevated myocardial infarction.Conclusion:Midodrine seems to ameliorate this protracted instability and may provide a means to decrease hospital length of stay in appropriate individuals.展开更多
Intravenous(IV)vasopressors are essential in the management of hypotension and shock.Initiation of oral vasoactive agents to facilitate weaning of IV vasopressors to liberate patients from the intensive care unit is c...Intravenous(IV)vasopressors are essential in the management of hypotension and shock.Initiation of oral vasoactive agents to facilitate weaning of IV vasopressors to liberate patients from the intensive care unit is common despite conflicting evidence regarding the benefits of this practice.While midodrine appears to be the most frequently studied oral vasoactive agent for this purpose,its adverse effect profile may preclude its use in certain populations.In addition,some patients may require persistent use of IV vasopressors for hypotension refractory to midodrine.The use of additional and alternative oral vasoactive agents bearing different mechanisms of action is emerging.This article provides a comprehensive review of the pharmacology,clinical uses,dosing strategies,and safety considerations of oral vasoactive agents and their application in the inten-sive care setting.展开更多
Vasovagal syncope is a common cause of recurrent syncope. Clinically, these episodes may present as an isolated event with an identifiable trigger, or manifest as a cluster of recurrent episodes warranting intensive e...Vasovagal syncope is a common cause of recurrent syncope. Clinically, these episodes may present as an isolated event with an identifiable trigger, or manifest as a cluster of recurrent episodes warranting intensive evaluation. The mechanism of vasovagal syncope is incompletely understood. Diagnostic tools such as implantable loop recorders may facilitate the identification of patients with arrhythmia mimicking benign vasovagal syncope. This review focuses on the management of vasovagal syncope and discusses the non-pharmacological and pharmacological treatment options, especially the use of midodrine and selective serotonin reuptake inhibitors. The role of cardiac pacing may be meaningful for a subgroup of patients who manifest severe bradycardia or asystole but this still remains controversial.展开更多
文摘Background:Clonidine is a centrally acting a2 adrenergic and imidazoline-1 receptor agonist that can cause somnolence,bradycardia,and hypotension within several hours of ingestion.Less well-described but observed by us locally is the observation that patients presenting after large overdoses including clonidine can have prolonged autonomic instability.As a result,they may require many days in hospital before recovery.We have previously used midodrine as an indirect antagonist with good effect;however,there are no previous reports of its use for this indication.Case presentation:We present the case of a young female patient who developed prolonged autonomic instability following a large overdose of clonidine(coingested with smaller doses of escitalopram+lisdexamfetamine)that was treated with midodrine but complicated by a type 2 non-ST segment elevated myocardial infarction.Conclusion:Midodrine seems to ameliorate this protracted instability and may provide a means to decrease hospital length of stay in appropriate individuals.
文摘Intravenous(IV)vasopressors are essential in the management of hypotension and shock.Initiation of oral vasoactive agents to facilitate weaning of IV vasopressors to liberate patients from the intensive care unit is common despite conflicting evidence regarding the benefits of this practice.While midodrine appears to be the most frequently studied oral vasoactive agent for this purpose,its adverse effect profile may preclude its use in certain populations.In addition,some patients may require persistent use of IV vasopressors for hypotension refractory to midodrine.The use of additional and alternative oral vasoactive agents bearing different mechanisms of action is emerging.This article provides a comprehensive review of the pharmacology,clinical uses,dosing strategies,and safety considerations of oral vasoactive agents and their application in the inten-sive care setting.
文摘Vasovagal syncope is a common cause of recurrent syncope. Clinically, these episodes may present as an isolated event with an identifiable trigger, or manifest as a cluster of recurrent episodes warranting intensive evaluation. The mechanism of vasovagal syncope is incompletely understood. Diagnostic tools such as implantable loop recorders may facilitate the identification of patients with arrhythmia mimicking benign vasovagal syncope. This review focuses on the management of vasovagal syncope and discusses the non-pharmacological and pharmacological treatment options, especially the use of midodrine and selective serotonin reuptake inhibitors. The role of cardiac pacing may be meaningful for a subgroup of patients who manifest severe bradycardia or asystole but this still remains controversial.
