SAMPLE POTS TREATMENTS/PATIENT PLAN
PATIENT NAME
HEALTH PLAN
Physician Information
Addressing/Treating
Medications/Appointments
 Appointments
 Medications
Action Items
 Physician Action Items
 Patient Action Items
 Complete Items
Primary Care
Dr. Name/Info
Cardiology
Dr. Name/Info
Not have my condition, and organizing my condition, take
over my life.
Blood Pressure
Variations
Central Line/Fluids
Mental Fog
Physical Activity
Gastroenterology
Dr. Name/Info
Pain Management
Dr. Name/Info
Psychiatry
Dr. Name/Info
Neurology
Dr. Name/Info
Rheumatology
Dr. Name/Info
Goal




Octreotide – 250mcg
QID
D5 Saline 1L
.9% NaCl 1L BID
Adderall – 10mg BID
 Cancel Appt
 Ordered Medication
 Order aggressive PT for
home.
 4/1 Tilt Table Test
Nausea/Vomiting
Chest Pain
Be able to stand up and go places without an escort.
 Keep blood sugar in range.
 Eat on a schedule.
 Keep BP under 140/90.
 No Infections this year
 Keep my professional persona alive.
 Do my program 3 days a week.
 Be able to swim a mile without stopping.
Not get nauseous before, during, and after every meal.
 Only puke once a week.
Be free from pain.
 Only need meds 2 days a week
Be at peace with my condition.
 Figure out how to handle pain without drugs.
Know what triggers crashes and prevent them.
 Understand why I shake and stop it.
Be able to walk down stairs.
 Be able to run 5 miles
Patient Burden
Chest Pain, Shaking
Joint Pain
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SAMPLE POTS TREATMENTS/PATIENT PLAN
POTENTIAL PHARMACOLOGICAL/PHYSICAL THERAPIES
Category
Treatment
Article Notes/Citations
referenced in (#) article
Dosage
POTS
type
Negative Outcomes
Diet
Don’t eat carbs.
(2)(3)
Exercise
Reconditioning
(1)(2)(3)
Aerobic exercise
20 min 3
times/wk
PD, H
If too vigorous, may
worsen symptoms
Hydration
(1)(2)(3)
2 L/d
PD
Edema
Salt
(1)(2)(3)
2–4 g/d
PD
Edema
Saline
Vasoconstrictors
Compression Socks
N/A
N/A
Fludrocortisone acetate
(1) Alternative is DDAVP
(2) Use w/ salt tablets. May reduce
renin!
(3-9)
0.1–0.2 mg qd
PD
Hypokalemia,
hypomagnesemia,
edema
Midodrine (ProAmatine)
(1) Add to Fludrocortisone/DDAVP
(2)Don’t use long term
(3-10)
5–10 mg tid
PD
Nausea, itching scalp,
supine hypertension
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SAMPLE POTS TREATMENTS/PATIENT PLAN
Clonidine HCI (Catapres)
(1)(2)(3) Hyperadrenergic
0.1–0.3 mg bid;
0.1–0.3 mg
patch/wk
H
Dry mouth, blurred
vision
Desmopressin acetate
(DDAVP)
(1) Alternative is DDAVP
(3)
0.1–0.2 mg qhs
PD
Hyponatremia,
headache
Octreotide acetate
(Sandostatin)
(1) For Refractory Pts
(2) Use if eating (splanchnic pooling)
is a problem
(3) helps, but SQ
50–200 μg SC tid
PD
Nausea, diarrhea,
gallstones, SC
Erythropoietin (Epogen,
Procrit)
(1) If nothing else works
(2) Can help increase cell mass but
expensive and risky.
(3) helped symptoms, no major
reduction in OT
(1) if Midodrine isn’t tolerated
(2)
(3)
10 000–20 000 U
SC/wk
PD
Pain at injection site,
expensive
5–10 mg tid
PD
Anorexia, insomnia,
dependency
Methylphenidate (Ritalin,
Methylin, Concerta, etc.)
Others
(2): Ergotamine, Ephedrine,
Pseudoephedrine, Yohimbine,
Theophylline
(3) Phenylepherine
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SAMPLE POTS TREATMENTS/PATIENT PLAN
ACH Inhibitor
SSRI
SRNI
(1) If Vasoconstrictors
don’t work, try these.
(1) SNRIs are better than
SSRI for POTS
(3) They anecdotally
work
Betablockers
Pyridostigmine bromide
(Mestinon)
(1) Use for postviral/autoimmune
(2) (3)(5-7)(9-10)
30–60 mg qd
PD
Nausea, diarrhea
Escitalopram oxalate
(Lexapro)
(1) if SSRI is used, use with a SNRI
(duloxetine/venlafaxine)
(3) They anecdotally work
10 mg qd
PD, H
Tremor, agitation, sexual
problems
Bupropion (Wellbutrin XL)
(1)
150–300 mg qd
PD, H
Tremor, agitation,
insomnia
Duloxetine HCI (Cymbalta)
(1) Use w/ SSRI
20–30 mg qd
PD, H
Nausea, sleep
disturbance
Venlafaxine HCI
(1) Use w/ SSRI
(3) anecdotally works
75 mg qd or bid
PD, H
Nausea, anorexia,
tremor
Others
(3) reboxetine and Sibutramine
Bisopropol
(2) Use w/ fludrocortisone
Page 4 of 5
SAMPLE POTS TREATMENTS/PATIENT PLAN
Alpha-2 agonists
Sinus Node Blocker
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Propranolol
(2) Use in low doses
(3) 10mg longterm works
Labetalol HCI (Trandate,
Normodyne)
(1) combined alpha/beta
labetalol/carvedilol may work better
Toprol
(4,7,8)
Methyldopa
(2)
(3) very limited evidence.
Ivabradine
(2) may be better than beta blockers
for sinus tach
(3) helps tach w/o messing with BP
100–200 md bid
H
Fatigue
H
Grubb, Blair. Postural Tachycardia Syndrome Clinican Update. American Heart Association. 2008.
Abed, Howraa. Diagnosis and Management of POTS. Journal of Geriatric Cardiology. March 2012.
A review of postural orthostatic tachycardia syndrome. Europace. 2009.
Brady, P. Inappropriate sinus tachycardia and Overlapping Syndromes. October 2005. PACE. Vol 28. Pp 112-1121.
Kanjawal, Y. The Postural Orthostatic Tachycardia Syndrome: Definitions, Dignosis, and Management. PACE. August 2003. Vol 26, pp 1747-1757.
Autonomic Nervous Sytem Disorders. Merck Manual.
Low, P. Postual Tachycardia Syndrome. March 20009. Journal of Cardiovascular Electrophysicology. Vol 20. Pp 352-358.
Thieben, M. Postural Orthostatic Tachycardia syndrome: The Mayo Clinic Experience. March 2007. Mayo Clin Proc. Vol 82. Pp308-313.
Maule, S. Orthostatic Hypotension: Evaluatino and treatment. Cardiovascular and Haematological Disorders – Drug Targets. Vol 7. Pp 63-70
Grubb, B. The postural tachycardia syndrome. A concise guide to diagnosis and management. January 2006. J. Cardiovac Electrophysiol. Vol 17. Pp 108-112.
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