The Orthostatic Intolerance (OI) Center
Medical Care for OI
• Overview
• Common Meds
• Other Factors to Consider
• Full List By What They Do
• Hyperadrenergic POTS • References
Overview of Medications
FDA-Approval: All the drugs listed have been approved by the Food and Drug Administration (FDA). The FDA approved drugs for use in specific diseases or conditions. However, it is part of a physician's medical license to prescribe medications for the specific diseases or conditions that have been approved and for other uses they consider appropriate.
Midodrine is the only drug approved by the FDA for treatment of orthostatic hypotension.8
The Food and Drug Administration (FDA) has not approved any drug for the treatment of POTS.5
The recommendations provided are 'off-label', which means they are based on the experience with the drugs in clinical practice and as reported in the medical literature.
Common Medications used for OI |
Action of the drug |
Why you are doing it - the problem it is meant to help |
| • Fludrocortisone | • Mineralcorticoid -holds water and salt in the body | • Low blood volume |
| • Midodrine • Stimulants (Dexedrine, Ritalin, Adderall) • Provigil |
• Peripheral vasoconstriction | • Blood pooling in the legs and abdomen when you stand up |
| • Pyridostigmine | • Change in the sensitivity of the special BP receptor cells in the neck and aorta | |
| • Pyridostigmine | • Control heart rate | • Control heart rate |
| • SSRI/SNRI: Prozac, Zoloft, Lexapro, Effexor, Cymbalta | • Serotonin regulation | • Change in the sensitivity of the special BP receptor cells in the neck and aorta. |
| • Beta-blockers: Atenolol, Metoprolol, Propranolol | • Beta blocker - decrease heart rate & the force of the cardiac contraction • Block peripheral vasodilation |
• Sympathetic (hormone/chemical) release |
| • Disopyramide (Norpace) | • Reduces the force of the cardiac contraction |
Full list includes other drugs used: includes Epo, ddAVP (Vasopressin), clonidine
- 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.
- Freeman, Roy. Neurogenic orthostatic hypotension.NEJM 2008;358(6):615-624. Abstract
- 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.
- Rowe, Peter. Managing Orthostatic Intolerance. Webinar. September 1, 2010. Hosted by CFIDS Association of American. Accessed June 1, 2012. Written material. Slides PDF. Video.
- Grubb BP, Karabin B. Cardiology patient page. Postural tachycardia syndrome: Perspectives for patients. Circulation. 2008;118:e61–e62. Abstract. Article PDF.
- Jacob G, Costa F, Shannon JR, Robertson RM et al. The Neuropathic Postural Tachycardia Syndrome. N Engl J Med 2000;343: 1008-14.
- 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
- .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.
- Low PA and Singer W. Update on Management of Neurogenic Orthostatic Hypotension. Lancet Neurol. 2008 May; 7(5): 451–458. Abstract. Article PDF.
- Mathias CJ. Autonomic diseases: management. J Neurol Neurosurg Psychiatry. 2003 Sep;74 Suppl 3:iii42-7. Abstract. Article.
Author: Kay E. Jewell, MD
Page Last Updated: August 11, 2012
