2026 Eastern States Conference

Title:
Midodrine use in hospitalized patients: a retrospective evaluation of prescribing practices and discharge continuation at a community hospital
Authors:
Harshini D Sobhan, PharmD, MSHS, Ruxandra Necula-Lee, PharmD, Maricelle Monteagudo-Chu, PharmD, BCIDP, BCPS, Shamsul Islam, PharmD, MBA
Learning Objective:
Audience members will be able to evaluate inpatient prescribing practices of midodrine and identify opportunities for optimization of use and improved transitions of care.
Background:
Midodrine is approved for symptomatic orthostatic hypotension, is frequently used off-label. This study evaluates indications, dosing, frequency, and duration of use, comparing new inpatient initiation versus continuation from home and at discharge.
Methods:
Retrospective chart review of adult patients (at least 18years old) admitted to the hospital, with an active inpatient midodrine order during January 1, 2025, to March 31, 2025. Excluded patients were seen in the Emergency Department and not admitted as inpatients, midodrine use less than 24 hours, and those who had additional visits during the study period. Data collected included demographics, indication for use, initiation type, duration of therapy, and discharge continuation. Descriptive statistics summarize patient and prescribing characteristics. Primary outcome is to evaluate the frequency of midodrine use based on indication, distinguishing between new inpatient start and home-medication continuation. Secondary outcome is to evaluate the duration of therapy, continuation of use at discharge and baseline systolic blood pressure prior to first dose for standing hypotension orders. 
Results:
A total of 179 patient charts were reviewed, with 119 patients included. The most common indications for midodrine use were hypotension outside the ICU (59.2%) and ICU hypotension for vasopressor sparing (29.4%). The average duration of therapy was 8.62 days + 9.77. Midodrine was used prior to admission in 31.9% of patients and newly initiated in 68.1%, with 40.7% of new starts occurring in the ICU. Among newly initiated patients, 22.2% continued therapy at discharge, including 12.1% of ICU patients. For hypotension orders outside the ICU, 74.6% were standing and 25.4% were as needed. Among standing orders, 87.2% had a specified systolic blood pressure (SBP) ≤ 120 mmHg, while 12.8%  specified SBP > 120 mmHg prior to start of therapy.
Conclusions:
Midodrine is commonly used to treat hypotension in the ICU and non-ICU settings. In our study, at least 20% of patients who started on midodrine during hospitalization were continued on therapy at discharge. We observed various ranges of blood pressure parameters within midodrine orders outside of the ICU settings, highlighting the importance of improved transitions of care. Further evaluation is needed to determine if standardization of parameters within the midodrine record is warranted.
 
 
Self-Assessment Question
Which pharmacist-driven strategy is best supported by this study to improve safe and appropriate inpatient midodrine use?
A. Encouraging routine continuation of midodrine at discharge for all ICU-started patients
B. Performing medication reconciliation with targeted reassessment of midodrine indication and duration
C. Limiting midodrine initiation to nephrology consults only
D. Avoiding midodrine use in patients with any history of hypotension