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However, in metastatic cases like Gavin Creels, surgery may not be as effective, and other treatment options are considered

Smith RL, Taylor KM, Friedman AB, Gibson RN, Gibson PR

Some researchers reduce to maintenance dosing Important considerations: MCAS patients are often highly sensitive

More commonly used than droxidopa: Midodrine was approved in the 1990s (droxidopa was approved in 2014) Most clinicians have longer experience with midodrine Midodrine is available as a generic & is less expensive Droxidopa is typically reserved for use as an add-on when midodrine is ineffective, or midodrine is not tolerated due to side effects Contraindications: hypertension heart failure acute kidney failure urinary retention thyrotoxicosis pheochromocytoma Side Effects: Supine hypertension WARNING : may cause marked hypertension when the patient is supine (laying down)

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