摘要Background:Clonidine is a centrally acting α2 adrenergic and imidazoline-1 receptor agonist that can cause somnolence,bradycardia,and hypotension within several hours of ingestion.Less well-described but observed by us locally is the observation that patients presenting after large overdoses including clonidine can have prolonged autonomic instability.As a result,they may require many days in hospital before recovery.We have previously used midodrine as an indirect antagonist with good effect;however,there are no previous reports of its use for this indication.Case presentation:We present the case of a young female patient who developed prolonged autonomic instability following a large overdose of clonidine(coingested with smaller doses of escitalopram+lisdexamfetamine)that was treated with midodrine but complicated by a type 2 non-ST segment elevated myocardial infarction.Conclusion:Midodrine seems to ameliorate this protracted instability and may provide a means to decrease hospital length of stay in appropriate individuals.