Beneficial effect of midodrine in hypotensive cirrhotic patients with refractory ascites.

Ascites is the most frequent complication of cirrhosis, occurring in nearly 50% of patients within 10 years after cirrhosis is diagnosed.1 A proportion of these patients require large-volume paracentesis (LVP) for symptom relief when other treatment modalities are unsuccessful or impossible. However, frequent LVP is associated with patient discomfort, decreased quality of life, and increased potential risks, such as circulatory dysfunction and related complications.2 Vasoconstrictors are known to have beneficial effects in patients with hepatorenal syndrome (HRS), as these agents can improve renal disease related to circulatory dysfunction.3-5 We report 2 patients requiring frequent LVP who benefited from midodrine treatment, as evidenced by the decreased volume of ascitic fluid drained; midodrine treatment also reduced the frequency of paracentesis and, thus, its potential risks.