Management of Hypotension and Bradycardia Caused by Spinal Cord Injury. The Usefulness of Midodrine and Methylxanthines

Document Type : Case Report


1 Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.

2 Department of Anesthesiology and Intensive Care, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

3 Department of Clinical Pharmacy, Faculty of Pharmacy, Gilan University of Medical Sciences, Rasht, Iran.


Spinal cord injury is a devastating chronic condition resulting in temporary or permanent motor,
sensory or autonomic dysfunction of the cord. The manifestation of spinal cord injury based on
the severity and involved areas could be different. Numerous studies have demonstrated that
bradycardia, hypotension, and orthostatic hypotension are present insignificant number of
patients after spinal cord injury which peaks at 4th day of injury. Although vasopressors are
common drugs that have been used to restore blood pressure and heart rate in patients with
neurogenic shock, there is limited data regarding pharmacologic management of bradycardia and
hypotension after spinal cord injury. Midodrine is a potent vasopressor approved for the
management of symptomatic orthostatic hypotension. Theophylline and aminophylline are
methylxanthine derivatives. There are very few case reports concerning the use of midodrine and
methylxanthines for treatment of hypotension in patients with spinal cord injury. In this case
report and review of the articles we report a 45 year old woman with a diagnosis of spinal cord
injury who was successfully managed with midodrine and aminophylline and then we review
current case reports. Based on our case report and other available data, midodrine as well as
methylxanthines can be suggested as therapeutic options for managing symptoms in spinal cord
injury patients.


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