Pharmacologic treatments for postural orthostatic tachycardia syndrome effectively improved symptoms and increased orthostatic tolerance, although the evidence is limited by small, underpowered studies.
Systematic Review
Do pharmacologic treatments improve symptoms and orthostatic tolerance in patients with postural orthostatic tachycardia syndrome?
Various pharmacologic treatments show positive impacts on POTS symptoms and orthostatic tolerance, but the current evidence base is limited by small, underpowered studies.
The literature on pharmacologic treatments for postural orthostatic tachycardia syndrome (POTS) is inconsistent and unstandardized. Therefore, we aimed to evaluate choices in pharmacologic treatment options for POTS and the challenges encountered in the studies. We searched numerous databases like PubMed, Scopus, Embase, Web of Science, and Google Scholar for literature published before April 8, 2023. The search was done to retrieve potential peer-reviewed articles that explored drug therapy in POTS. Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were used to conduct the systematic review. Of the 421 potential articles assessed, 17 met the inclusion criteria. Results demonstrated that pharmacologic treatment options for POTS were effective in reducing symptoms of POTS, but most of the studies were underpowered. Several were terminated due to various reasons. Midodrine ivabradine, bisoprolol, fludrocortisone, droxidopa, desmopressin, propranolol, modafinil, methylphenidate, and melatonin have been studied with positive impact but sample sizes that were low in the range of 10-50 subjects. Therefore, we concluded the treatment options effectively improve symptoms of POTS and increase orthostatic tolerance, but more evidence is needed as most studies had a low sample size and thus are underpowered.
Vasavada et al. (Thu,) conducted a systematic review in Postural Orthostatic Tachycardia Syndrome (POTS). Pharmacologic treatments (e.g., midodrine, ivabradine, beta-blockers, fludrocortisone) vs. Placebo or alternative drug was evaluated on Cardiovascular parameters (standing heart rate and blood pressure) and symptom burden. Pharmacologic treatments for postural orthostatic tachycardia syndrome effectively improved symptoms and increased orthostatic tolerance, although the evidence is limited by small, underpowered studies.