From the Guidelines
Treatment for Postural Orthostatic Tachycardia Syndrome (POTS) should prioritize non-pharmacological approaches, including increased fluid intake, salt consumption, compression garments, and a structured exercise program, as these interventions address the underlying pathophysiology of POTS and have been shown to improve symptoms and quality of life 1.
Key Components of POTS Treatment
- Increased fluid intake: 2-3 liters daily
- Salt consumption: 10-12g daily
- Compression garments for the lower body
- Structured exercise program focusing on recumbent exercises initially
Pharmacological Interventions
- Beta-blockers like propranolol (10-40mg twice daily) or metoprolol (25-100mg daily) to reduce heart rate
- Fludrocortisone (0.1-0.2mg daily) to increase blood volume
- Midodrine (2.5-10mg three times daily) to increase peripheral vascular resistance
- Pyridostigmine (30-60mg three times daily) to enhance autonomic nervous system function
- Ivabradine (2.5-7.5mg twice daily) for heart rate control without affecting blood pressure
Additional Considerations
- Patients should rise slowly from lying or sitting positions, avoid prolonged standing, and maintain adequate hydration, especially during hot weather or exercise
- Treatment should be individualized and often requires a combination approach
- The most recent and highest quality study 1 supports the use of non-pharmacological and pharmacological interventions, including beta-blockers, fludrocortisone, midodrine, and pyridostigmine, to improve symptoms and quality of life in patients with POTS.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
POTS Treatment Overview
- POTS (Postural Orthostatic Tachycardia Syndrome) is a chronic disorder characterized by orthostatic intolerance with excessive heart rate increase without hypotension during upright posture 2.
- Treatment typically begins with patient education and non-pharmacologic treatment options, and various medications are often used to address specific symptoms 2.
Medications Used in POTS Treatment
- Beta-blockers, such as bisoprolol, have been shown to be effective in improving symptoms in patients with POTS 3.
- Fludrocortisone has also been used to treat POTS, and has been shown to improve symptoms in some patients 3, 4.
- Midodrine, ivabradine, and selective serotonin reuptake inhibitors have also been used to treat POTS, with some favorable effects reported in individual studies 5, 4.
- Supplemental therapies such as iron, vitamin D, and α lipoic acid may also be used to treat POTS, although more research is needed to confirm their effectiveness 5.
Treatment Outcomes and Prognosis
- A prospective study of 58 patients with POTS found that orthostatic symptoms improved in most patients over a 1-year follow-up period, with more than one-third of patients no longer fulfilling tilt criteria for POTS 6.
- Another study found that treatment with medication, including beta-blockers and fludrocortisone, can improve symptoms in patients with POTS, although the quality of the evidence is generally low 4.
- Overall, the prognosis for patients with POTS is relatively favorable, with many patients experiencing improvement in symptoms over time 6.