Subsection: Medications
    •  Overview
    •  Common Meds
    •  Other Factors to Consider
    •  Full List By What They Do
   •  Hyperadrenergic POTS
   •  References

Full List of Medications - Grouped By What They Do

There are numerous medications available to treat orthostatic intolerance. This list breaks them down by what they do, what part of the orthostatic problem they address. Some are commonly used. Others are used for specific conditions or when the symptoms are not responding to other treatments.


Medications that increase blood volume

  • Fludrocortisone (Florinef)
  • Oral contraceptive pills
  • Clonidine
  • Vasopressin- Desmopressin – DDAVP (Can be used to supplement volume expansion & reduce nocturnal diuresis)3
  • Erythropoeitin (EPO) (also increases red blood cell mass and may cause constriction of the vessels)

Medications that interfere with the release of or response to epinephrine and norepinephrine

  • Beta-blockers (e.g., atenolol, propranolol, metoprolol, labetalol)
    • Pindolol has partial agonist activity. It is reported to be useful in some patients, especially those with very low supine norepinephrine concentrations.2
  • Disopyramide (Norpace)
    • Use for vasovagal syncope – not established
  • Angiotensin converting enzyme inhibitors/angiotensin receptor blockers 11

Medications that improve vasoconstriction

  • Stimulants: (e.g., methylphenidate [Ritalin] or dextroamphetamine [Dexedrine])
  • Midodrine (Proamatine)
  • Modafanil (Provigil)
  • Selective serotonin reuptake inhibitors (SSRI) and SNRI (see lists in tabs below for their names) These medications may also affect the central nervous system reflex pathways in NMH as well. 1
  • Pseudoephedrine (Sudafed) (Ephedrine) (These drugs were used more in the past. They are generally not used now because of their many effects and side effects. (Do Not take within 4 hours before sleep. Side Effects: supine high blood pressure, tachycardia, central nervous system side effect -e.g. anxiety, tremulousness.
  • Phenylephrine
  • Clonidine
  • Yohimbe (Herb)
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Control heart rate increase

  • Pyridostigmine bromide

Somatostatin analogues

  • Somatostatin1, 2 
  • Octreotide2

    Octreotide has been used to reduce the low blood pressure after eating (postprandial hypotension). Octreotide is a splanchnic vasoconstrictor, it constricts (narrows) the vessels in the intestinal areas. This decreases the splanchnic pooling that follows eating. When they are both taken, Midodrine and Octreotide have synergistic pressor effects - they work differently and are more effective together. The 2 drugs act by different mechanisms as they affect different vascular beds. These agents might also be useful in managing vasovagal faint due to splanchnic hypervolemia during orthostatic stress.

Prevent the veins from dilating (getting larger so they hold more blood)

  • Nonsteroidal Anti-Inflammatory Drugs(NSAID) (Ibuprofen,Indomethacin) This use is controversial.2, 13
  • Blocks dopamine receptor: metoclopramide (Reglan), domperidone (Motilium)13 (These are used for GI symptoms and not generally used for orthostatic problems)
  • Beta-2 adrenoceptor blockade (propranolol)13
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Increase cardiac output (how much blood the heart pumps out with each beat)

  • Beta blockers with sympathomimetic activity adrenoceptor blockade (pindolol)13

Prevent postprandial hypotension (Low blood pressure after eating)

  • Somatostain analogue: octreotide13
  • Caffeine (adenosine receptor blockade)13


  • Used in mastocytosis and occasionally in dysautonomia from diabetes.2


  • Hydralazine2
  • Ergotamine - constriction of the veins2, 13
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  • SSRI Drugs
  • SNRI Drugs
SSRI = Selective Serotonin Reuptake Inhibitor
The general name of the drug is first; this is the "generic" name. The brand name (the name given to it by the manufacturer) is in parentheses. (Brand names)
  • Citalopram (Celexa, Cipramil, Cipram, Dalsan, Recital, Emocal, Sepram, Seropram, Citox, Cital)
  • Dapoxetine (Priligy)
  • Escitalopram (Lexapro, Cipralex, Seroplex, Esertia)
  • Fluoxetine (Depex, Prozac, Fontex, Seromex, Seronil, Sarafem, Ladose, Motivest, Flutop, Fluctin (EUR), Fluox (NZ), Depress (UZB), Lovan (AUS), Prodep (IND))
  • Fluvoxamine (Luvox, Fevarin, Faverin, Dumyrox, Favoxil, Movox)
  • (Upstene) (discontinued)
  • Paroxetine (Paxil, Seroxat, Sereupin, Aropax, Deroxat, Divarius, Rexetin, Xetanor, Paroxat, Loxamine, Deparoc)
  • Sertraline (Zoloft, Lustral, Serlain, Asentra)
  • Zimelidine (Zelmid, Normud) (discontinued)
SNRI = Serotonin Norepinephrine Reuptake Inihibitors
The general name of the drug is in blue; thisis the "generic" name. The brand name (the name given to it by the manufacturer) is in parentheses. (Brand names)
  • Venlafaxine (Effexor) – The first and most commonly used SNRI. It was introduced by Wyeth in 1994. The reuptake effects of venlafaxine are dose-dependent. At low doses (<150 mg/day), it acts only on serotonergic transmission. At moderate doses (>150 mg/day), it acts on serotonergic and noradrenergic systems, whereas at high doses (>300 mg/day), it also affects dopaminergic neurotransmission. (From Wikipedia)
  • Duloxetine (Cymbalta, Yentreve)
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  1. Rowe, Peter.  General Information Brochure on Orthostatic Intolerance and Its Treatment. June 2010. Accessed from http://www.cfids.org/webinar/cfsinfo2010.pdf. Accessed May 28.2012. Grubb BP. Postural tachycardia syndrome. Circulation. 2008;117:2814–2817. Abstract. Article PDF.
  2. Medow MS, Stewart JM, Sanyal S, Mumtaz A, Stca D and Frishman WH. Pathophysiology, Diagnosis, and Treatment of Orthostatic Hypotension and Vasovagal Syncope. Cardiology in Review 2008;16(1):4-20. Abstract
  3. Freeman, Roy. Neurogenic orthostatic hypotension.NEJM 2008;358(6):615-624. Abstract
  4. Grubb BP, Karabin B. Cardiology patient page. Postural tachycardia syndrome: Perspectives for patients. Circulation. 2008;118:e61–e62. Abstract. Article PDF.
  5. Jacob G, Costa F, Shannon JR, Robertson RM et al. The Neuropathic Postural Tachycardia Syndrome. N Engl J Med 2000;343: 1008-14.
  6. Johnson JN, Mack KJ, Kuntz NL, Brands CK, Porter CJ and Fischer PR. Postural Orthostatic Tachycardia Syndrome: A Clinical Review. Pediatr Neuro 2010; 42:77-85. Abstract.
  7. Low PA and Singer W. Update on Management of Neurogenic Orthostatic Hypotension. Lancet Neurol. 2008 May; 7(5): 451–458. Abstract. Article PDF.
  8. Medow MS, Stewart JM. The postural tachycardia syndrome. Cardiol Rev. 2007;15:67–75. Abstract.
  9. Moya, Guidelines for the diagnosis and management of syncope (version 2009). European Heart Journal (2009); 30: 2631-2671. Abstract. Article PDF.
  10. Figueroa JJ, Basford JR, Low PA. Preventing and treating orthostatic hypotension: As easy as A, B, C. Cleve Clin J Med. 2010 May;77(5):298-306.  Abstract.  Article PDF.
  11. Zeng C, et al. Randomized, double-blind, placebo-controlled trial of oral enalapril in patients with neurally mediated syncope. Am Heart J 1998;136:852-8.
  12. Sakakibara R, Matsuda S, Uchiyama T, Yoshiyama M, Yamanishi T, Hattori T. The effect of intranasal desmopressin on nocturnal waking in urination in multiple system atrophy patients with nocturnal polyuria. Clin Auton Res 2003;13:106-8. Abstract.
  13. Mathias CJ. Autonomic diseases: management. J Neurol Neurosurg Psychiatry. 2003 Sep;74 Suppl 3:iii42-7.  Abstract.   Article.


Author: Kay E. Jewell, MD
Last Page Update: August 11, 2012