Medications For Hyperadrenergic POTS

In hyperadrenergic POTS, there is an increase level of norepinephrine when standing. The following recommendations should be considered:¹

Therefore, patients often respond best to agents that block norepinephrine or its effects.^{2, 3}

• One agent that is particularly helpful is clonidine HCI in either pill or patch form.
  • Start the oral form at 0.1 mg PO 1 to 2 times a day and gradually increase as needed.
  • Once a dose has been found that works, the patch form of clonidine is quite useful. It provides a constant and continuous amount of the drug for up to 1 week at a time.
• The combination of labetalol and carvedilol works in some patients. Use of only one is less effective because of the potential to make symptoms worse by the unopposed stimulation of carvedilol.
• Methyldopa has been reported to be useful in some patients, as has phenobarbital.
• In addition, both the SSRIs and SNRIs (norepinephrine reuptake inhibitors) are useful in select patients..

References

1. Grubb BP. Postural tachycardia syndrome. Circulation. 2008;117:2814–2817. Abstract.Article PDF.
2. Vincent S, Robertson D. Hyperadrenergic postural tachycardia syndrome. In: Robertson D, ed. Primer on the Autonomic Nervous System. San Diego, Calif: Elsevier Academic Press; 2004:344 –345.
3. Shannon JR, Flattem NL, Jordan J, Jacob G, Black BK, Biaggioni I, Blakely RD, Robertson D. Orthostatic intolerance and tachycardia associated with norepinephrine transporter deficiency. N Engl J Med. 2000;342:541–549.