Case Reports
Saturday, November 11, 2023
11:30 AM–01:00 PM
Abstract
Introduction: Pruritus and paresthesias caused by midodrine, while reported in the literature, are rarely identified by clinicians in practice although midodrine is commonly used to manage ICU and intradialytic hypotension. We report a case of a patient who experienced profound pruritus and paresthesias following the administration of midodrine.
Case: A 35-year-old Hispanic female with a history of end stage kidney disease who presented with lightheadedness and low blood pressure was admitted for worsening hypotension after hemodialysis. The patient was given 10 mg of midodrine prior to hemodialysis, which she had never received before. She reported experiencing severe itching and tingling of the scalp that traveled downward through her trunk, including bilateral arms and wrists, 15 minutes after receiving midodrine. The patient also described feeling extremely anxious during the reaction and expressed fear of experiencing a similar sensation if midodrine were to be administered again. The reaction resolved in 30 minutes without treatment.
Discussion: Although pruritis and paresthesias (especially of the scalp area) have been reported in the midodrine package insert, it is rarely seen in practice. A retrospective review of 87 patients at The University of Texas Southwestern Medical Center found no documented cases of this adverse effect. In this case, pharmacy was involved in the investigation of the reaction and determined it was most likely attributable to midodrine. The proposed mechanism is potentially related to the alpha-1 receptor agonism of midodrine, causing contraction of muscles responsible for piloerection.
Conclusion: Healthcare providers must be vigilant of the potential adverse effects of midodrine as they are capable of causing significant discomfort, severe enough to deter the patient from further administrations. Strategies to avoid the adverse effects of midodrine may include reducing the dose and employing other methods to combat hypotension.
Presenting Author
Layla Kassem Pharm.D.Parkland Health & Hospital System
Authors
Andrew Tomlinson M.D.
UT Southwestern Medical Center
Linda Uchal Pharm.D.
UT Southwestern Medical Center