brand logo

Am Fam Physician. 2022;105(4):online

Clinical Question

Can midodrine decrease recurrent episodes of vasovagal syncope?

Bottom Line

Midodrine is a vasoconstrictor used to prevent orthostatic hypotension and may reduce the likelihood of recurrence of vasovagal syncope in patients with frequent episodes. It seems to work completely or not at all; during this study, the patients who had at least one episode of syncope had several episodes over the course of the year regardless of whether they received midodrine or placebo. (Level of Evidence = 1b−)


The investigators enrolled 133 adults without orthostatic hypotension who had fainted at least twice (median = six times) in the past year and who did not have other known causes of syncope. Patients were randomized, concealed allocation unknown, to receive placebo or midodrine for one year. Treatment was started at 5 mg three times daily, during daylight hours, with the dosage increased up to 10 mg three times daily, if tolerated. Over one year, 58% of patients in the midodrine group were syncope-free compared with 39% in the placebo group (number needed to treat = 5). Midodrine was associated with a longer time to first recurrence of syncope (P = .035). In the subset of participants who had at least one syncope episode during the study, the rates were similar between treatments (i.e., 3.6 to 3.8 episodes per year).

Already a member/subscriber?  Log In


From $165
  • Immediate, unlimited access to all AFP content
  • More than 130 CME credits/year
  • AAFP app access
  • Print delivery available

Issue Access

  • Immediate, unlimited access to this issue's content
  • CME credits
  • AAFP app access
  • Print delivery available
Purchase Access:  Learn More

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to

This series is coordinated by Natasha Pyzocha, DO, contributing editor.

A collection of POEMs published in AFP is available at

Continue Reading

More in AFP

More in Pubmed

Copyright © 2022 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.