QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Résumé Extracto Full Text PDF Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Articles Ahead of Print [Order Reprint] Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Young, T. M Articles by Mathias, C. J Search for Related Content PubMed PubMed Citation Articles by Young, T. M Articles by Mathias, C. J

Taste and Smell Disturbance with the -Adrenoceptor Agonist Midodrine

MRCP, Clinical Research Fellow, Neurovascular Medicine Unit, Imperial College London, St. Mary's Hospital, London, England

Christopher J Mathias

FRCP, Professor of Neurovascular Medicine, Neurovascular Medicine Unit, Imperial College London, St. Mary's Hospital; Autonomic Unit, The National Hospital of Neurology and Neurosurgery, University College London

Reprints: Tim M Young MRCP, Neurovascular Medicine Unit, Imperial College London, St. Mary's Hospital, Praed St., London W2 1NY, England, fax 441207-886-1540, dtimyoung{at}hotmail.com

OBJECTIVE: To report a case of a disturbance of taste and smell associated with the -adrenoceptor agonist midodrine.

CASE SUMMARY: A 64-year-old white man with autonomic failure was started on midodrine 5 mg/day as treatment for orthostatic hypotension. After 3 months, the dose was increased to 12.5 mg/day, whereupon he noted a new onset of taste and smell disturbance. These symptoms made eating so unpleasant that the man greatly reduced his food intake, leading to significant weight loss. In addition, he experienced well-recognized adverse effects of midodrine, such as scalp pruritus, after the dose increase. All symptoms resolved with a dose reduction of midodrine (to 5 mg/day), and the patient increased his food intake, resulting in a return to his initial body weight.

DISCUSSION: Midodrine is commonly associated with dose-dependent adverse effects, such as scalp pruritus and cutis anserina. Disorders of taste and smell have not been previously reported with midodrine, although it has been suggested that other sympathomimetic drugs may have effects on the olfactory threshold. Severe disorders of taste and smell may impact not only on a patient's quality of life, but also on their physical well-being, with significant weight loss being reported in this case. According to the Naranjo probability scale, this patient's taste and smell disturbance was probably associated with midodrine.

CONCLUSIONS: The use of midodrine may be associated with taste and smell disturbance. This case suggests that such an association is likely to be dose dependent.

Key Words: autonomic failure, midodrine, smell and taste disturbance

Published Online, October 5, 2004. www.theannals.com, DOI 10.1345/aph.1E171