From the Research
Hydroxyzine may be considered as an adjunct therapy for POTS patients, particularly those with anxiety symptoms, but it should not be used as a first-line treatment due to its potential to worsen orthostatic symptoms. The most recent and highest quality study on POTS management is from 2024 1, which emphasizes the importance of lifestyle modifications and phenotype-based treatment approaches. According to this study, first-line treatment for all POTS patients focuses on lifestyle modifications, including increased fluid and salt intake, compression garment use, physical reconditioning, and postural training. Some key points to consider when using hydroxyzine for POTS include:
- Typically prescribed at 10-25mg as needed up to three times daily
- Works as an antihistamine with anxiolytic properties that can help reduce heart rate in some cases
- May cause drowsiness, dry mouth, and constipation
- Should be used cautiously as antihistamines can sometimes worsen orthostatic symptoms through their anticholinergic effects
- Best used as an adjunct therapy alongside core POTS treatments like increased fluid intake, salt supplementation, compression garments, and possibly medications like beta-blockers, midodrine, or fludrocortisone that more directly address the cardiovascular dysregulation in POTS Other studies, such as those from 2021 2, 2020 3, 2023 4, and 2022 5, also discuss the management of POTS, but the 2024 study 1 provides the most recent and comprehensive overview of the condition. It's essential to consult with a healthcare provider familiar with POTS before starting hydroxyzine, as treatment needs to be tailored to the individual's specific symptoms and underlying causes.