norepinephrine + midodrine

**Norepinephrine + midodrine** is a combination of two vasopressor agents, both of which act primarily by increasing vascular tone and blood pressure, but through different mechanisms. - **Norepinephrine** (also called noradrenaline) is a sympathomimetic agent that acts as an agonist mainly at alpha-adrenergic receptors, causing potent vasoconstriction and increasing systemic vascular resistance, making it a mainstay intravenous pressor in critical care settings. - **Midodrine** is an oral alpha-1 adrenergic agonist, which increases blood pressure by constricting blood vessels. It is primarily used for symptomatic orthostatic hypotension and has been investigated as part of oral vasopressor regimens for conditions such as hepatorenal syndrome. - This combination is not a marketed pharmaceutical product but refers to the clinical use or co-administration of both agents, particularly in refractory or severe hypotension such as in hepatorenal syndrome or the critical care setting, where oral (midodrine) and intravenous (norepinephrine) vasopressors may be used together if single-agent therapy is inadequate. - The rationale for combined use is additive or synergistic vasopressor effects via different routes and pharmacokinetics, but it can increase the risk of excessive hypertension and related adverse effects[9][2][1]. - There is evidence comparing norepinephrine and midodrine (typically in combination with octreotide) as separate regimens for hepatorenal syndrome, but direct concurrent combination use is uncommon in standard guidelines[1][2][3][5].

Other names

norepinephrine and midodrine