POTSWhat do the medicines have behind them?
GUESS FIRST
How many medicines have FDA approval for POTS?
No medicine has FDA approval for POTS.
Doctors use medicines approved for other conditions and match them to your symptoms and blood pressure. These cards show what each one has behind it. They give no advice on what to take, and your clinician decides what fits your history.
PICK A MEDICINE BELOW
See where each one acts on the body.
Medicines aim at the heart rate, the blood vessels or the blood volume.
Illustration with example numbers. The trial results are in each card.
Low-dose propranolol
ACTS ON HEART RATE
Slows the heart rate. Low doses worked better than high doses in the main trial.
APPROVED FOR
Off-label. Approved for hypertension, angina and other conditions; no approval covers POTS.
GUIDELINE RATING
HRS 2015: Class IIb.
LARGEST RANDOMIZED TRIAL IN OUR DATA
54 people (Raj 2009). One dot is one person.
Pyridostigmine
ACTS ON HEART RATE
Raises acetylcholine signaling, which slows heart rate on standing.
APPROVED FOR
Off-label. Approved for myasthenia gravis.
GUIDELINE RATING
HRS 2015: Class IIb.
LARGEST RANDOMIZED TRIAL IN OUR DATA
17 people (Raj 2005). One dot is one person.
Midodrine
ACTS ON BLOOD VESSELS
Tightens blood vessels so less blood pools in the legs.
APPROVED FOR
Off-label. Approved for symptomatic orthostatic hypotension, with a boxed warning for supine high blood pressure.
GUIDELINE RATING
HRS 2015: Class IIb.
LARGEST RANDOMIZED TRIAL IN OUR DATA
20 people (Ross 2014). One dot is one person.
Fludrocortisone
ACTS ON BLOOD VOLUME
A salt-retaining steroid that expands blood volume.
APPROVED FOR
Off-label. Approved for adrenal insufficiency.
GUIDELINE RATING
HRS 2015: Class IIb (level C).
LARGEST RANDOMIZED TRIAL IN OUR DATA
None randomizedThe only report (Freitas 2000) was open-label and studied 11 women.
Ivabradine
ACTS ON HEART RATE
Slows the sinus node directly without lowering blood pressure.
APPROVED FOR
Off-label. Approved for heart failure. Not for use in pregnancy.
GUIDELINE RATING
Discussed in the Canadian 2020 statement. Newer than the 2015 US consensus.
LARGEST RANDOMIZED TRIAL IN OUR DATA
22 people (Taub 2021). One dot is one person.
Droxidopa and modafinil
ACTS ON BLOOD VESSELS
Droxidopa raises norepinephrine. Modafinil promotes wakefulness and gets used for brain fog.
APPROVED FOR
Off-label. Droxidopa is approved for neurogenic orthostatic hypotension. Modafinil is approved for narcolepsy, sleep apnea and shift work disorder.
GUIDELINE RATING
No guideline rating found.
LARGEST RANDOMIZED TRIAL IN OUR DATA
54 people (Kpaeyeh 2014). One dot is one person. Standing heart rate matched placebo.
Want the non-drug options and the medicines that can worsen POTS too? Open every treatment card