Novel pharmacotherapeutic options for the treatment of postural orthostatic tachycardia syndrome

ABSTRACT

Introduction

Postural tachycardia syndrome (POTS) is a disorder characterized by a constellation of symptoms including lightheadedness, fatigue, and palpitations when upright, associated with an increase in the heart rate (HR) of > 30 beats per minute when changing from a lying down to standing position or head-up tilt position and not associated with orthostatic hypotension. The causes as well as the management of POTS are not quite fully understood.

Areas covered

We performed a literature review on the diagnosis and management of POTS, and this article includes an overview of novel pharmacotherapeutic options for the treatment of (POTS), although an effective treatment has not been established.

Expert opinion

POTS is a clinical syndrome characterized by a constellation of symptoms that are nonspecific. No single etiology or unified hypothesis could be identified. In fact, multiple pathophysiological mechanisms have been proposed, and none of the suggested medications have been approved by the FDA for this indication. Further understanding of the autonomic nervous system and its adjustment to standing position is needed to provide better management strategies.

KEYWORDS:

• Management
• medications
• pharmacotherapy
• postural orthostatic tachycardia syndrome
• Orthostatic intolerance

Article highlights

• POTS is a clinical syndrome with nonspecific symptoms including postural, non-postural and systemic, resulting from a heterogenous group of disorders.

• The diagnosis of POTS requires a high clinical suspicion, detailed clinical history and physical exam.

• Non-pharmacological treatment options should be offered as first line therapy to all patients with POTS.

• Pharmacotherapy and neuromodulation are reserved for patients with refractory POTS symptoms despite non-pharmacological treatment.

Abbreviations

AChR	=	Acetylcholine receptor
AV node	=	Atrioventricular node
ALA	=	alpha lipoic acid
COMPASS 31	=	Composite Autonomic Symptom Score 31
IVIG	=	Intravenous Immunoglobin
POTS	=	Postural orthostatic tachycardia
RAAS	=	Renin-angiotensin-aldosterone system

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.