The Naturetic Effects of Long-Term Use of Midodrine on Patients with Liver Cirrhosis and Refractory Ascites

Background: splanchnic vasodilatation is a major contributor to development of ascites n cirrhotic patients and associated with poor sodium excretion. So Midodrine which is, alpha 1 agonist, may improve circulatory abnormality in cirrhotic patients via its vaso-constrictive action thus leading to better natriuresis.

Aim: to assess the efficacy and the safety of midodrine (alpha adrenergic agonist) on patients with liver cirrhosis as regard sodium excretion.

Patients and Methods: A total of 80 cirrhotic patients with refractory ascites were enrolled in this prospective study. Patients consisted of 40 patients receiving standard medical therapy (dietary salt restriction and diuretics) and 40 patients receiving standard medical therapy +Midodrine in a dose of (7.5 mg /8hours) for one month. Body weight, abdominal girth, complete blood count, liver and renal function tests, serum electrolytes and 24-h urine volume and Na level were obtained at the start and the end of the study

Results: Body weight and abdominal girth significantly decreased in midodrine group patients compared to control group (p <0.001). Also, 24-h urinary volume and Na excretion were significantly higher in midodrine group patients at the end of the study compared to SMT patients (p <0.001).

Conclusions: Midodrine could be used safely as an adjuvant to SMT (salt restriction and diuretics) in cirrhotic patients with refractory ascites in a dose of 7.5 mg TDS with better outcomes evidenced by reduced body weight and increase Na excretion in urine