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Refractory ascites results from splanchnic vasodilatation and maximal activation of the sympathetic nervous system and is typically managed with high-dose diuretics. However, constrictors (e.g., midodrine) and sympatholytics (e.g., clonidine), alone or in combination, might improve ascites control in patients with refractory or recurrent ascites.
To evaluate the efficacy of these drugs, investigators conducted a pilot study in which they randomized 60 patients to receive clonidine (0.1 mg every 12 hours), midodrine (7.5 mg every 8 hours), or both clonidine and midodrine combined with a standard diuretic regimen (furosemide and spironolactone) or the standard diuretic regimen only for 1 month. The primary endpoint was control of ascites, clas…