Can Midodrine Prevent Recurrence of Vasovagal Syncope?

Patients with frequent episodes of vasovagal syncope have few proven therapeutic options to prevent recurrence. Investigators randomized 133 patients (median age, 32; 73% women) with recurrent vasovagal syncope and no hypertension or serious comorbid conditions to receive 1-year courses of either placebo or the α-1 agonist midodrine (2.5 mg twice daily, titrated during 2 weeks to as high as 10 mg thrice daily, as tolerated). Median number of syncope episodes during the year prior to randomization was 6.

In intent-to-treat analysis at 12 months, significantly fewer patients who received midodrine had at least one episode of syncope (42% vs. 61%; number needed to treat, ≈5), and the time to first syncope was significantly longer with midodrine…