Background: Splanchnic vasodilation is a significant contributor to the development of ascites in cirrhotic patients. So, midodrine, an alpha-one agonist, may improve circulatory abnormality in cirrhotic patients via its vasoconstrictive action, thus lessening refractory ascites.
Aim: To assess the efficacy and the safety of midodrine (alpha adrenergic agonist) on patients with liver cirrhosis and refractory ascites.
Patients and Methods: 80 cirrhotic patients with refractory ascites were enrolled in this prospective study. The patients consisted of 40 patients receiving standard medical therapy (SMT) (dietary salt restriction and diuretics) and 40 patients receiving standard medical therapy +midodrine in a dose of (7.5 mg /8 hours) for one month. Body weight, abdominal circumference, complete blood count, liver and renal function tests, serum electrolytes and 24-hour urine volume, and Na level were obtained at the study's start and end.
Results: Body weight and abdominal circumference significantly decreased in midodrine group patients compared to the control group (p <0.001). Also, 24-hour urinary volume and Na excretion were substantially higher in midodrine group patients at the study's end than in SMT patients (p <0.001). Additionally, both systolic and diastolic blood pressure were higher in midodrine patients at the end of the study(P<0.001).
 
Conclusions: Midodrine could be used safely as an adjuvant to SMT in cirrhotic patients with refractory ascites, with better outcomes evidenced by reduced body weight and increased Na excretion in urine.