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| ==Treatment== | | ==Treatment== |
| There is at this time only one drug approved by the [[Food and Drug Administration|FDA]] to treat [[orthostatic intolerance]], however several classes of drugs often provide symptom control and relief. Treatments must be carefully tested due to medication sensitivity often associated with POTS patients, and each patient will respond to different therapies in different ways. Most patients will respond to some form of treatment.
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| ===Fludrocortisone===
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| The first line of treatment for POTS is usually [[fludrocortisone]], or Florinef, a [[corticosteroid]] used to increase sodium retention and thus increase blood volume and blood pressure. An increase in sodium and water intake must coincide with fludrocortisone therapy for effective treatment. Dietary increases in sodium and sodium supplements are often used. [[Gatorade]] is also effective in providing both sodium and fluid.
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| ===Beta Blockers===
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| [[Beta blockers]] such as [[atenolol]] and [[propanolol]] are often prescribed to treat POTS. These medications work by blocking the effects of [[epinephrine]] and [[norepinephrine]] released by the autonomic nervous system. Beta blockers also reduce sympathetic activity by blocking sympathetic impulses.
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| ===Midodrine===
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| [[Midodrine]] (Proamatine), is approved by the U.S. [[FDA]] to treat [[orthostatic hypotension]], a condition related to POTS. It is a stimulant that causes [[vasoconstriction]] and thereby increases [[blood pressure]] and allows more blood to return to the upper parts of the body. Use of midodrine is often discontinued due to intolerable side-effects, and it is known to cause supine hypertension (high blood pressure when lying down).
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| ===Antidepressants===
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| Antidepressants, especially [[selective serotonin reuptake inhibitors]] (SSRIs) such as [[Prozac]], [[Zoloft]], [[Celexa]], [[Lexapro]], and [[Paxil]], can be extremely effective in re-regulating the autonomic nervous system and raising blood pressure. Some studies indicate that [[serotonin-norepinephrine reuptake inhibitor]]s (SNRIs) such as [[Effexor]] and [[Cymbalta]] are even more effective. [[Tricyclic antidepressants]], tetracyclic antidepressants, and [[monoamine oxidase inhibitors]] are also occasionally, but rarely, prescribed. A combination of two antidepressants, usually an [[SSRI]] or [[SNRI]] with [[Wellbutrin]] or [[Remeron]], is also shown to be very effective.
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| ===Stimulants===
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| Medications used to treat [[attention deficit disorder|ADD]] and [[attention deficit hyperactivity disorder|ADHD]] such as [[Ritalin]] and [[Adderall]] are used to balance dopamine levels, increase vasoconstriction, and increase blood pressure.
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| ===Anxiolytics===
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| Anti-anxiety medications, such as [[Xanax]], [[Ativan]], and [[Klonopin]], can be used to combat imbalances of [[adrenaline]] usually seen with POTS patients.
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| ===Other Medications===
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| *[[Angiotensin converting enzyme inhibitors]], or ACE inhibitors, are used to increase [[vasoconstriction]], cardiac output, and sodium and water retention.
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| *[[Clonidine]] can work in patients with reduced sympathetic activity. Ironically an anti-hypertensive drug, Clonidine promotes production and release of [[epinephrine]] and [[norepinephrine]].
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| *[[Disopyramide]], or Norpace, is an antiarrhythmic medication that inhibits the release of [[epinephrine]] and [[norepinephrine]].
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| *[[Erythropoietin]], used to treat anemia via [[intravenous infusion]], is very effective at increasing blood volume. It is seldom used, however, due to the dangers of increasing the [[hematocrit]], the inconvenience of intravenous infusion, and its prohibitively expensive cost.
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| *[[Pregabalin]], or Lyrica, an [[anticonvulsant]] drug, has been shown to be especially effective in treating [[neuropathic pain]] associated with POTS. In fact, Lyrica is currently the only prescription drug approved by the FDA to treat [[fibromyalgia]]. Some POTS patients also report improvement in concentration and energy while on Lyrica.
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| *[[Pseudoephedrine]] and [[phenylephrine]], over the counter [[decongestants]], increase [[vasoconstriction]] by promoting the release of [[norepinephrine]].
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| *[[Pyridostigmine]], or Mestinon, inhibits the breakdown of [[acetylcholine]], promoting autonomic nervous system activity. It is especially effective in patients who exhibit symptoms of excessive sympathetic activity.
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| *[[Theophylline]], a drug used to treat respiratory diseases such as [[COPD]] and [[asthma]], is occasionally prescribed at low doses for POTS patients. Theophylline increases cardiac output, increases blood pressure, and stimulates [[epinephrine]] and [[norepinephrine]] production. Due to its very narrow [[therapeutic index]], Theophylline is known to cause a wide variety of side-effects and even [[toxicity]].
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| *Women who report a worsening of symptoms during [[menstruation]] will often use combined (containing both estrogen and progestin) forms of [[hormonal contraception]] to prevent hormonal changes and an aggravation of their condition.
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| ===Dietary Changes=== | | ===Dietary Changes=== |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
For patient information click here
Synonyms and Keywords: postural tachycardia syndrome, POTS
Overview
Historical Perspective
Pathophysiology
Differentiating POTS from Other Disorders
Risk Factors
Natural History, Complications, Prognosis
Diagnosis
Laboratory Studies
Tilt Table Testing
Treatment
Dietary Changes
- Alcohol has been shown to drastically exacerbate all types of orthostatic intolerance due to its vasodilation and dehydration properties. It should be avoided whenever possible because of its adverse effects and its interactivity with many of the medications prescribed to POTS patients.
- Caffeine helps some POTS patients due to its stimulative effects, however, other patients report a worsening of symptoms with caffeine intake. Each patient should experiment to determine whether caffeine helps or hurts his or her condition.
- Diets high in carbohydrates have been connected to impaired vasoconstrictive action. Eating foods with lower carbohydrate levels can mildly improve POTS symptoms.
- Eating frequent, small meals can reduce gastrointestinal symptoms associated with POTS by requiring the diversion of less blood to the abdomen.
- Patients diagnosed with POTS will usually be advised to maintain a high sodium diet in order to augment the effects of their medication regimen, especially if that regimen includes fludrocortisone. Patients should also drink plenty of fluids, with a recommended intake of at least two liters per day and as much as 500 milliliters every two hours throughout the day.
Physical Therapy
POTS symptoms can be worsened by postural asymmetries, restrictions in mobility, and areas of adverse mechanical tension in the nervous system. These physical abnormalities can be relieved with gentle manual therapies including neural mobilization (or neural tension work), myofascial release, and cranio-sacral therapy.
External Body Pressure
Pressure garments can reduce symptoms associated with orthostatic intolerance by constricting blood pressures with external body pressure. Compression hose and anti-embolism stockings, both knee and thigh-high, provide relief for many patients. For especially severe cases, military anti-shock trousers and anti-gravity suits, or g-suits can be helpful but also limiting.
Exercise
Exercise is very important for maintaining muscle strength and avoiding deconditioning. Though many POTS patients report difficulty exercising, some form of exercise is essential to controlling symptoms and eventually, improving the condition.
External Links
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