Midodrine

In a Mayo Clinic observational cohort, off-label midodrine use was associated with improved blood pressure and reduced vasopressor support measures. Midodrine is an oral alpha-1 adrenergic agonist approved by the FDA for symptomatic orthostatic hypotension. Midodrine stimulates alpha-1 receptors in venous and arterial vasculature, causing vasoconstriction and increasing systolic blood pressure. Midodrine has approximately 93% enteral bioavailability, begins acting within 1 hour, and lasts 3 to 4 hours. Enteral midodrine is proposed to address sepsis-associated hypotension without invasive vascular access.