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1.
Chest ; 159(4): e189-e191, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-34022016

RESUMO

A trisomy 21 neonate presented with congenital chylous pleural effusion and ascites that was refractory to conventional pharmacotherapy. Midodrine, an oral alpha-1-adrenoreceptor agonist, achieved remission of chylous effusion without any adverse effects. To the best of our knowledge, this is the first neonatal case of successful management of congenital chylous pleural effusion and ascites with midodrine.


Assuntos
Quilotórax/congênito , Ascite Quilosa/tratamento farmacológico , Midodrina/uso terapêutico , Derrame Pleural/tratamento farmacológico , Agonistas de Receptores Adrenérgicos alfa 1/uso terapêutico , Adulto , Quilotórax/complicações , Quilotórax/tratamento farmacológico , Ascite Quilosa/etiologia , Feminino , Humanos , Recém-Nascido , Derrame Pleural/etiologia , Gravidez
2.
J Comp Eff Res ; 10(8): 673-683, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33860672

RESUMO

Background: The effect of midodrine on lactate clearance has not been assessed in critically ill patients yet. Objective: The goal of this study was to assess the effect of adjunctive midodrine therapy on lactate clearance in patients with septic shock. Materials & methods: Patients with septic shock were assigned to receive either adjunctive midodrine 10 mg three-times a day for 5 days (midodrine group = 15 patients) or not (control group = 13 patients). Results: The lactate clearance was significantly faster in the midodrine group than the control group (p = 0.049) with a large effect size (ηp2 = 0.141). Conclusion: When midodrine was added to intravenous vasopressors, it significantly accelerated lactate clearance in patients with septic shock. Trial registration number: IRCT20100228003449N25 (Clinicaltrials.gov).


Assuntos
Midodrina , Choque Séptico , Humanos , Ácido Láctico , Midodrina/uso terapêutico , Projetos Piloto , Choque Séptico/tratamento farmacológico , Vasoconstritores/uso terapêutico
3.
Am Heart J ; 237: 5-12, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33689731

RESUMO

BACKGROUND: The cornerstone of the treatment of vasovagal syncope (VVS) is lifestyle modifications; however, some patients incur life-disturbing attacks despite compliance with these treatments which underscores the importance of pharmacological interventions. METHODS: In this open-label multi-center randomized controlled trial, we are going to randomize 1375 patients with VVS who had ≥2 syncopal episodes in the last year into three parallel arms with a 2:2:1 ratio to receive midodrine, fludrocortisone, or no medication. All patients will be recommended to drink 2 to 3 liters of fluids per day, consume 10 grams of NaCl per day, and practice counter-pressure maneuvers. In medication arms, patients will start on 5 mg of midodrine TDS or 0.05 mg of fludrocortisone BD. After one week the dosage will be up-titrated to midodrine 30 mg/day and fludrocortisone 0.2 mg/day. Patient tolerance will be the principal guide to dosage adjustments. We will follow-up the patients on 3, 6, 9, and 12 months after randomization. The primary outcome is the time to first syncopal episode. Secondary outcomes include the recurrence rate of VVS, time interval between first and second episodes, changes in quality of life (QoL), and major and minor adverse drug reactions. QoL will be examined by the 36-Item Short Form Survey questionnaire at enrollment and 12 months after randomization. CONCLUSION: The COMFORTS trial is the first study that aims to make a head-to-head comparison between midodrine and fludrocortisone, against a background of lifestyle modifications for preventing recurrences of VVS and improving QoL in patients with VVS.


Assuntos
Fludrocortisona/uso terapêutico , Midodrina/uso terapêutico , Síncope Vasovagal/tratamento farmacológico , Agonistas de Receptores Adrenérgicos alfa 1/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Quimioterapia Combinada , Humanos , Qualidade de Vida , Recidiva , Inquéritos e Questionários , Resultado do Tratamento
5.
Cardiol Young ; 31(5): 817-821, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33407967

RESUMO

BACKGROUND: Vasovagal syncope is the most common cause of syncope in childhood and its treatment is not at a satisfactory level yet. We aimed to investigate patients who were diagnosed with vasovagal syncope, did not benefit from conventional treatment, received midodrine treatment, and to evaluate their response to midodrine treatment. METHODS: Files of 24 patients who were diagnosed with recurrent vasovagal syncope, did not benefit from non-pharmacological treatments, and received midodrine treatment during June 2017-October 2019 were retrospectively analysed. RESULTS: In total, 24 patients received a treatment dose of midodrine at 5 mg/day (2.5 mg BID) included in the study. The mean number of syncope was 5.75 ± 2.67 prior to treatment. Following treatment, the mean number of syncope was 0.42 ± 0.89. It was observed that syncope episodes did not recur in 17 patients, but it recurred in 4 out of 7 patients in the first 3 months of the treatment and did not recur in the following months. The episodes improved in two patients with an increase in the treatment dose, but the syncope episodes continued in only one patient. CONCLUSION: It was concluded that midodrine treatment was effective and safe in adolescents with recurrent vasovagal syncope.


Assuntos
Midodrina , Síncope Vasovagal , Adolescente , Criança , Humanos , Midodrina/uso terapêutico , Recidiva , Estudos Retrospectivos , Síncope Vasovagal/tratamento farmacológico
7.
Eur J Gastroenterol Hepatol ; 33(1): 102-106, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32243349

RESUMO

BACKGROUND: Hepatorenal syndrome (HRS) remains a serious complication of cirrhosis with a high mortality rate. There is little information on the effect of standardizing albumin, midodrine and octreotide combination on treatment response in patients with HRS. OBJECTIVE: The aim of the study was to determine the impact of a standardized HRS treatment regimen on renal function recovery. The primary outcome was full response rate. Secondary outcomes included partial and no response rates, 30-day all-cause mortality, ICU length of stay (LOS), hospital LOS, liver transplantation and total dose of albumin. METHODS: This retrospective study evaluated the impact of using a standardized approach with albumin, midodrine and octreotide on treatment response rates compared to a historical group. RESULTS: Of the patients with HRS, 28 received a standardized approach with albumin, midodrine and octreotide while 60 received a nonstandardized approach. Ten percent of patients achieved full response in the prestandardization group compared with 25% in the poststandardization group (P = 0.07). Renal replacement therapy was significantly more prevalent in the prestandardization group vs. poststandardization group (45% vs. 21.4%, P = 0.03). Liver transplantation was performed significantly more often in the prestandardization group compared the poststandardization group (23% vs. 3.6%, P = 0.02). Amount of albumin used was statistically lower in the poststandardization group (425 vs. 332 g, P = 0.05). No significant differences in days of HRS treatment, mortality rate, hospital and ICU LOS were observed. CONCLUSION: A trend towards improved treatment response rate was observed after standardizing the HRS treatment regimen. Standardized therapy led to significantly lower rates of renal replacement therapy and liver transplantation, suggesting patients in poststandardization were effectively managed medically without requiring further intervention.


Assuntos
Síndrome Hepatorrenal , Midodrina , Albuminas/uso terapêutico , Quimioterapia Combinada , Síndrome Hepatorrenal/diagnóstico , Síndrome Hepatorrenal/tratamento farmacológico , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/tratamento farmacológico , Midodrina/efeitos adversos , Octreotida/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento , Vasoconstritores/efeitos adversos
8.
Medicine (Baltimore) ; 99(40): e21533, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019383

RESUMO

RATIONALE: Midodrine is widely used in the treatment of hypotensive states, there have been no reports of myoclonus associated with midodrine use in hypotension with chronic kidney disease. PATIENT CONCERNS: We report a 58-year-old female patient with chronic kidney disease (CKD) presenting with involuntary tremor 2 h after taking midodrine, which became more frequent after 6 h. Brain CT and neurological examination did not yield findings of note. Blood chemistry showed serum albumin of 3.1 g/L, ALT of 19 U/L, AST of 22 U/L, SCr of 273.9 µmol/L, K of 2.94 mmol/L, Ca of 1.63 mmol/L, and Mg of 0.46 mmol/L. Her BP was maintained at 83-110/56-75 mmHg. Her urine volume was 600-1000 mL/d, and her heart rate was within a range of 90-100 beats/min. DIAGNOSIS: Chronic kidney disease (CKD), hypotension, metabolic acidosis, hypocalcemia, hypokalemia, and hypomagnesemia. INTERVENTIONS: Midodrine treatment was stopped and the patient was treated with intravascular rehydration and furosemide. Myoclonus ceased one day after midodrine withdrawal. LESSONS: Oral midodrine is widely used in the treatment of orthostatic hypotension, recurrent reflex syncope and dialysis-associated hypotension and the adverse effects are mostly mild. However, clinicians should be alert for midodrine-induced myoclonus, especially in patients with CKD.


Assuntos
Agonistas de Receptores Adrenérgicos alfa 1/efeitos adversos , Hipotensão/tratamento farmacológico , Midodrina/efeitos adversos , Mioclonia/induzido quimicamente , Administração Oral , Agonistas de Receptores Adrenérgicos alfa 1/administração & dosagem , Feminino , Humanos , Hipotensão/etiologia , Pessoa de Meia-Idade , Midodrina/administração & dosagem , Insuficiência Renal Crônica/complicações
9.
Intensive Care Med ; 46(10): 1884-1893, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32885276

RESUMO

PURPOSE: ICU discharge is often delayed by a requirement for intravenous vasopressor medications to maintain normotension. We hypothesised that the administration of midodrine, an oral α1-adrenergic agonist, as adjunct to standard treatment shortens the duration of intravenous vasopressor requirement. METHODS: In this multicentre, randomised, controlled trial including three tertiary referral hospitals in the US and Australia, we enrolled adult patients with hypotension requiring a single-agent intravenous vasopressor for ≥ 24 h. Subjects received oral midodrine (20 mg) or placebo every 8 h in addition to standard care until cessation of intravenous vasopressors, ICU discharge, or occurrence of adverse events. The primary outcome was time to vasopressor discontinuation. Secondary outcomes included time to ICU discharge readiness, ICU and hospital lengths of stay, and ICU readmission rates. RESULTS: Between October 2012 and June 2019, 136 participants were randomised, of whom 132 received the allocated intervention and were included in the analysis (modified intention-to-treat approach). Time to vasopressor discontinuation was not different between midodrine and placebo groups (median [IQR], 23.5 [10-54] vs 22.5 [10.4-40] h; difference, 1 h; 95% CI - 10.4 to 12.3 h; p = 0.62). No differences in secondary endpoints were observed. Bradycardia occurred more often after midodrine administration (5 [7.6%] vs 0 [0%], p = 0.02). CONCLUSION: Midodrine did not accelerate liberation from intravenous vasopressors and was not effective for the treatment of hypotension in critically ill patients.


Assuntos
Hipotensão , Midodrina , Adulto , Austrália , Humanos , Hipotensão/tratamento farmacológico , Unidades de Terapia Intensiva , Vasoconstritores/uso terapêutico
11.
BMJ Case Rep ; 13(6)2020 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-32554459

RESUMO

Hypothalamic lesions can compromise its essential regulatory roles resulting in critical disruption of temperature and blood pressure homoeostasis. We present the case of a 55-year-old woman who had been previously submitted to several neurosurgical procedures aimed at treating idiopathic hydrocephalus. She presented to our department with recurring episodes of hypothermia and wide blood pressure variations, which had been worsening over the last few years. After extensive complementary workup, which excluded new neurological lesions or endocrinological conditions, hypothalamic dysfunction was assumed to be the cause of this syndrome. She was successfully treated with midodrine and on-demand captopril, which resulted in adequate control of her blood pressure. This case highlights the rare and unpredictable consequences of damage to the hypothalamus, depicting the favourable result of a heretofore unpublished medical approach.


Assuntos
Midodrina/uso terapêutico , Complicações Pós-Operatórias , Disautonomias Primárias/tratamento farmacológico , Terceiro Ventrículo/cirurgia , Ventriculostomia/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Disautonomias Primárias/etiologia , Resultado do Tratamento
12.
Acta Biomed ; 91(1): 70-78, 2020 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-32191657

RESUMO

BACKGROUND: Gastroesophageal reflux disease (GERD) is a common disease with various clinical presentations. Acid suppression with proton pump inhibitors and lifestyle modification may not lead to satisfactory response in a substantial portion of patients. We investigated the possible effect of midodrine in patients with refractory GERD. METHODS: Patients suffering from GERD and were refractory to one-month course of pantoprazole 40mg twice daily entered the study. This was a pilot, randomized, double-blind, and placebo-controlled study. After randomization, one group received Midodrine 5mg before meals for one month, and the other group received placebo for the same period. Meanwhile, pantoprazole was continued 40mg twice daily in both arms. The severity of symptoms was evaluated by the visual scoring system. Quality of life (QoL) in both groups was measured using a standardized version of Quality of Life in Reflux and Dyspepsia questionnaire (QOLRAD). RESULTS: A total of twenty patients were enrolled in this study. There was a significant interaction between the groups and time on all measured scores based on QOLRAD questionnaire. All the markers in the Midodrine group had significant improvement over time, but the placebo group did not show any significant improvement. Both visual severity score and total QoL score in Midodrine arm showed a U shape change during  6 weeks. CONCLUSIONS: Midodrine before a meal could be useful in alleviating symptoms and improving QoL in the patients with refractory gastroesophageal disease.


Assuntos
Agonistas de Receptores Adrenérgicos alfa 1/uso terapêutico , Refluxo Gastroesofágico/tratamento farmacológico , Midodrina/uso terapêutico , Adulto , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pantoprazol/uso terapêutico , Projetos Piloto , Inibidores da Bomba de Prótons/uso terapêutico , Qualidade de Vida , Escala Visual Analógica
13.
J Crit Care ; 57: 148-156, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32145658

RESUMO

Shock is common in the intensive care unit, affecting up to one third of patients. Treatment of shock is centered upon managing hypotension and ensuring adequate perfusion via administration of fluids and catecholamine vasopressors. Due to the risks associated with catecholamine vasopressors, interest has grown in using catecholamine-sparing agents such as midodrine and methylene blue. Midodrine is an orally administered alpha-1 adrenergic agonist while methylene blue is an intravenously administered blue dye used to restore vascular tone and increase blood pressure. Separate MEDLINE, Scopus, and Embase database searches were conducted to assess literature revolving around these agents. Examples of search terms included "midodrine", "methylene blue", "critically ill", "shock", and "catecholamine-sparing." Several studies have evaluated their use in patients with shock and found potential benefits in terms of causing significant elevations in blood pressure and hastening catecholamine vasopressor discontinuation with few adverse effects; however, robust evidence is lacking for these off-label indications. Because of the variety of dosing strategies used and the incongruences between patient populations, it is also challenging to define finite recommendations. This review aims to summarize current evidence for the use of midodrine and methylene blue as catecholamine-sparing agents in critically ill patients with resolving or refractory shock.


Assuntos
Catecolaminas/administração & dosagem , Cuidados Críticos/métodos , Azul de Metileno/administração & dosagem , Midodrina/administração & dosagem , Choque Séptico/tratamento farmacológico , Vasoconstritores/administração & dosagem , Pressão Sanguínea , Estado Terminal , Humanos , Hipotensão/tratamento farmacológico , Unidades de Terapia Intensiva , Uso Off-Label , Segurança do Paciente
14.
Am J Cardiol ; 125(10): 1582-1593, 2020 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-32204870

RESUMO

Neurogenic orthostatic hypotension (nOH), a drop in blood pressure upon standing resulting from autonomic malfunction, may cause debilitating symptoms that can affect independence in daily activities and quality-of-life. nOH may also be associated with cardiovascular comorbidities (e.g., supine hypertension, heart failure, diabetes, and arrhythmias), making treatment decisions complicated and requiring management that should be based on a patient's cardiovascular profile. Additionally, drugs used to treat the cardiovascular disorders (e.g., vasodilators, ß-blockers) can exacerbate nOH and concomitant symptoms. When orthostatic symptoms are severe and not effectively managed with nonpharmacologic strategies (e.g., water ingestion, abdominal compression), droxidopa or midodrine may be effective. Droxidopa may be less likely than midodrine to exacerbate supine hypertension, based on conclusions of a limited meta-analysis. In conclusion, treating nOH in patients with cardiovascular conditions requires a balance between symptom relief and minimizing adverse outcomes.


Assuntos
Sistema Cardiovascular/fisiopatologia , Hipotensão Ortostática/fisiopatologia , Hipotensão Ortostática/terapia , Droxidopa/uso terapêutico , Humanos , Midodrina/uso terapêutico , Simpatomiméticos/uso terapêutico
15.
Spinal Cord ; 58(9): 959-969, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32203065

RESUMO

STUDY DESIGN: Clinical trial. OBJECTIVES: Individuals with spinal cord injury (SCI) above T6 experience impaired descending cortical control of the autonomic nervous system, which predisposes them to hypotension. However, treatment of hypotension is uncommon in the SCI population because there are few safe and effective pharmacological options available. The primary aim of this investigation was to test the efficacy of a single dose of midodrine (10 mg), compared with placebo, to increase and normalize systolic blood pressure (SBP) between 110 and 120 mmHg during cognitive testing in hypotensive individuals with SCI. Secondary aims were to determine the effects of midodrine on cerebral blood flow velocity (CBFv) and global cognitive function. SETTING: United States clinical research laboratory. METHODS: Forty-one healthy hypotensive individuals with chronic (≥1-year post injury) SCI participated in this 2-day study. Seated SBP, CBFv, and cognitive performance were monitored before and after administration of identical encapsulated tablets, containing either midodrine or placebo. RESULTS: Compared with placebo, midodrine increased SBP (4 ± 13 vs. 18 ± 24 mmHg, respectively; p < 0.05); however, responses varied widely with midodrine (-15.7 to +68.6 mmHg). Further, the proportion of SBP recordings within the normotensive range did not improve during cognitive testing with midodrine compared with placebo. Although higher SBP was associated with higher CBFv (p = 0.02), global cognitive function was not improved with midodrine. CONCLUSIONS: The findings indicate that midodrine increases SBP and may be beneficial in some hypotensive patients with SCI; however, large heterogeneity of responses to midodrine suggests careful monitoring of patients following administration. CLINICAL TRIALS REGISTRATION: NCT02307565.


Assuntos
Pressão Sanguínea/efeitos dos fármacos , Circulação Cerebrovascular/efeitos dos fármacos , Cognição/efeitos dos fármacos , Hipotensão/tratamento farmacológico , Hipotensão/etiologia , Midodrina/farmacologia , Traumatismos da Medula Espinal/complicações , Vasoconstritores/farmacologia , Adulto , Doença Crônica , Estudos Cross-Over , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Midodrina/administração & dosagem , Avaliação de Resultados em Cuidados de Saúde , Vasoconstritores/administração & dosagem
16.
Dig Dis Sci ; 65(5): 1539-1548, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31571102

RESUMO

INTRODUCTION: Type 1 hepatorenal syndrome (HRS) is a fatal complication of cirrhosis. Treatments trend toward HRS reversal, but few show clear mortality benefit. We sought to quantify the progress-or lack thereof-in improving outcomes of type 1 HRS over time. METHODS: We performed a systematic review and meta-analysis for randomized controlled trials (RCTs) comparing type 1 HRS outcomes including (a) overall survival (liver transplant-free survival if reported) and (b) HRS reversal. Each study arm was analyzed separately to look at changes in outcomes over time. RCTs published comparing medical treatments for type 1 HRS were searched using several databases through July 31, 2019. RESULTS: Fourteen RCTs (28 arms) involving 778 participants enrolled between 2002 and 2018 were included. Twelve RCTs measured HRS reversal. In conjunction with albumin (or plasma expander), the most common medications used were terlipressin (13 arms), antibiotics (7), norepinephrine (6), dopamine (4), and midodrine/octreotide (3). Pooled survival rate was 34.6% (95% CI 26.4-43.8), and pooled HRS reversal rate was 42.8% (95% CI 34.2-51.9). Regression analyzing the incremental effect of the year the RCT was initiated showed that more recent studies were not associated with improved survival (OR 1.02, 95% CI 0.94-1.11, p = 0.66) or HRS reversal rates (OR 1.03, 95% CI 0.96-1.11, p = 0.41). There was no survival improvement when RCTs with endpoints assessed ≤ or > 1 month were analyzed separately with respective OR of 1.07 (95% CI 0.95-1.20, p = 0.26) and 0.97 (95% CI 0.85-1.12, p = 0.70). CONCLUSION: Outcomes have not improved for patients with type 1 HRS since 2002. There is a need to improve prevention and treatment of type 1 HRS.


Assuntos
Síndrome Hepatorrenal/tratamento farmacológico , Síndrome Hepatorrenal/mortalidade , Adulto , Albuminas/uso terapêutico , Antibacterianos/uso terapêutico , Dopamina/uso terapêutico , Quimioterapia Combinada , Feminino , Síndrome Hepatorrenal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Midodrina/uso terapêutico , Norepinefrina/uso terapêutico , Octreotida/uso terapêutico , Substitutos do Plasma/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Análise de Regressão , Taxa de Sobrevida , Terlipressina/uso terapêutico , Resultado do Tratamento , Vasoconstritores/uso terapêutico , Adulto Jovem
17.
Ann Clin Transl Neurol ; 7(1): 112-120, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31856425

RESUMO

OBJECTIVE: The efficacy and safety of 1-month atomoxetine and midodrine therapies were compared. Three-month atomoxetine and combination therapies were investigated for additional benefits. METHODS: This prospective open-label randomized trial included 50 patients with symptomatic neurogenic orthostatic hypotension (nOH). The patients received either atomoxetine 18 mg daily or midodrine 5 mg twice daily and were evaluated 1 and 3 months later. Those who still met the criteria for nOH at 1 month received both midodrine and atomoxetine for an additional 2 months, and if not, they continued their initial medication. The primary outcome was an improvement in orthostatic blood pressure (BP) drop (maximum BP change from supine to 3 min after standing) at 1 month. The secondary endpoints were symptom scores, percentage of patients with nOH at 1 and 3 months. RESULTS: Patients with midodrine or atomoxetine treatment showed comparative improvement in the orthostatic BP drop, and overall only 26.2% of the patients had nOH at 1 month, which was similar between the treatment groups. Only atomoxetine resulted in significant symptomatic improvements at 1 month. For those without nOH at 1 month, there was additional symptomatic improvement at 3 months with their initial medication. For those with nOH at 1 month, the combination treatment resulted in no additional improvement. Mild-to-moderate adverse events were reported by 11.6% of the patients. INTERPRETATION: One-month atomoxetine treatment was effective and safe in nOH patients. Atomoxetine improved orthostatic BP changes as much as midodrine and was better in terms of ameliorating nOH symptoms.


Assuntos
Inibidores da Captação Adrenérgica/farmacologia , Agonistas de Receptores Adrenérgicos alfa 1/farmacologia , Cloridrato de Atomoxetina/farmacologia , Hipotensão Ortostática/tratamento farmacológico , Midodrina/farmacologia , Inibidores da Captação Adrenérgica/administração & dosagem , Inibidores da Captação Adrenérgica/efeitos adversos , Agonistas de Receptores Adrenérgicos alfa 1/administração & dosagem , Agonistas de Receptores Adrenérgicos alfa 1/efeitos adversos , Idoso , Cloridrato de Atomoxetina/administração & dosagem , Cloridrato de Atomoxetina/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Midodrina/administração & dosagem , Midodrina/efeitos adversos , Avaliação de Resultados em Cuidados de Saúde , Estudos Prospectivos
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