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Auton Neurosci. 2018 Dec;215:28-36. doi: 10.1016/j.autneu.2018.04.008. Epub 2018 May 4.

Pharmacotherapy for postural tachycardia syndrome.

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Department of Neural and Behavioral Sciences, Penn State College of Medicine, 500 University Drive, Mail Code H109 Hershey, PA, USA.
Autonomic Dysfunction Center, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada. Electronic address:


Postural tachycardia syndrome (POTS) is a disorder characterized by the presence of orthostatic symptoms (including lightheadedness, palpitations, nausea, dyspnea, and tremulousness) as well as excessive upright tachycardia. POTS predominantly affects women of childbearing age. Treating POTS involves a multi-faceted approach using non-pharmacological and pharmacological interventions. There are no pharmacological treatments that are currently United States Food and Drug Administration (FDA) approved for POTS due to lack of randomized controlled trials. Yet, several medications can improve POTS symptoms and are supported by small prospective studies or retrospective case series. Drugs that are most commonly used for POTS target the following mechanisms 1) blood volume expansion, 2) reduction of heart rate, 3) peripheral vasoconstriction and 4) sympatholysis. Pharmacological approaches can also be used to target specific symptoms including "brain fog," fatigue, sleep, and depression. This review outlines pharmacological approaches for treating POTS and summarizes evidence supporting each treatment approach.


Autonomic nervous system diseases; Orthostatic intolerance; Postural orthostatic tachycardia syndrome; Postural tachycardia syndrome; Tachycardia; Therapeutics

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