Vasoconstrictors: Midodrine (ProAmatine 2.5-10 mg TID Fedorowski 2018) Droxidopa (100-600 mg TID may be also tested, but is contraindicated in pregnancy)Įffective in hypovolemic subtype of POTS and low blood pressure phenotype with pronounced orthostatic intolerance ( Fedorowski 2018). Fludrocortisone may be continued in pregnancy at 0.05-0.1 mg daily ( Morgan et al. The dose should never total more than 0.4 mg daily as adrenal suppression may occur. It can also reduce levels of plasma renin activity and be counterproductive in those with low blood volume. Thermotabs can be helpful at supplementing both sodium and potassium when taking Florinef. Florinef can deplete potassium and magnesium – supplements may be needed. This drug mimics aldosterone, which helps the body reabsorb sodium from the kidneys into the blood and secrete potassium into the urine. They are often prescribed in tandem with salt tablets. These steroids increase plasma volume and help the body retain both salt and water. This is one of the most commonly prescribed medications for POTS. May worsen supine hypertension and hypokalemia ( Fedorowski 2018). Recommended for the hypovolemic subtype of POTS and those with low blood pressure. Mineralocorticoids: Fludrocortisone (Florinef 0.1-0.2 mg daily Raj et al.

Has been used safely in pregnancy for women with myasthenia gravis for decades and a dose of 30 mg BID may help women with POTS whose symptoms worsen during pregnancy ( Morgan et al. When acetylcholinesterase is inhibited, however, the level of acetylcholine increases in the synapse and is available to bind its receptor for a longer duration. These are reversible inhibitors of the enzyme acetylcholinesterase that normally breaks down acetylcholine, the neurotransmitter of the parasympathetic nervous system. Particularly helpful in patients with suspected autonomic neuropathy, gastrointestinal dysfunction and non-specific muscle weakness ( Fedorowski 2018 ). They can improve sleep when taken at bedtime.Ĭholinesterase Inhibitors: Pyridostigmine Bromide (Mestinon 10-60 mg BID/TID Fedorowski 2018) This reduces activity of the sympathetic nervous system and decreases heart rate, decreases release of renin, and dilates the blood vessels which reduces blood pressure. Clonidine works by stimulating the inhibitory alpha-2 adrenergic receptors in the medulla oblongata in the central nervous system. These medications decrease sympathetic activity and blood pressure. Generally recommended for those with hyperadrenergic POTS and hypertensive tendency on standing ( Fedorowski 2018). Adverse effects include blood pressure lowering, peripheral edema and slowing of peristaltic movements in the intestines.Ĭentrally acting sympatholytic drugs: Clonidine (Catepres 0.1-0.2 mg BID/TID Raj et al. As calcium channels blockers also relax small muscles in blood vessels and bronchi, dilating them, and simultaneously slow electrical activity in the heart to control heart rate, they might be tested in patients with POTS -associated unexplained chest pain and dyspnea. Some patients may suffer from so called “microvascular dysfunction” or coronary spasms in the heart producing angina-like symptoms, or, alternatively, from asthma, which may result in shortness of breath. This calcium channel blockers can be effective for those with higher blood pressure, migraine, and chest pain ( Fedorowski 2018). Verapamil: (40-80 mg BID/TID Fedorowski 2018)

Not recommended for women who are pregnant or trying to get pregnant. This medication slows the heart rate and increases the amount of blood moved with each heartbeat. 2022 )Įffective in people with low blood pressure or when beta-blockers are not well tolerated ( Fedorowski 2018). Propranolol may be continued in pregnancy at 5 mg BID ( Morgan et al. However, beta blockers can reduce plasma renin activity and be counterproductive in those with low blood volume. A low dose of propranolol blunts the pounding fast heart rate feeling without lowering the blood pressure. Beta blockers are most useful in people with elevated norepinephrine levels, beta receptor hypersensitivity, hyperadrenergic state and those suffering from angina, hypertension, or cardiac arrhythmias. Beta blockers decrease heart rate, force of contraction, and conduction velocity through the heart. Beta Blockers : Propranolol (Inderal 10-40 mg TID Fedorowski 2018 ) Bisoprolol (2.5 -10 mg once or twice daily)īeta-blockers are especially recommended in hyperadrenergic subtype associated with sinus tachycardia > 120 bpm on standing ( Fedorowski 2018 ).

Extra heartbeat in pots