Acute midodrine overdose: a case report

Abstract Midodrine is a prodrug metabolized to the peripheral acting alpha agonist desglymidodrine and is used to treat orthostatic hypotension. Reports of overdose are rare, consequently there is little guidance regarding treatment of overdose. We report a case of toxicity following midodrine overdose and describe clinical findings and response to treatment. We also review the prior reported cases to determine what clinical findings are consistent and suggest a therapeutic approach. A 65-year-old man ingested 500 milligrams of midodrine. The patient presented to the emergency department within 45 min of the ingestion asymptomatic but with a blood pressure of 246/151 mmHg and heart rate of 69 beats per minute. The patient was treated for approximately 24 h with intravenous nitroglycerine with decrease in blood pressure. The patient recovered without apparent adverse sequelae. Midodrine overdose produces marked hypertension and relative bradycardia. These effects occur rapidly and resolve. Nitroglycerin appears to be safe and effective in controlling blood pressure following midodrine overdose.