Common Medications Used to Treat POTS

Every patient is different, and doctors often try different combinations to find what works best. Here are the most commonly used medications for POTS and how they help:

1. Beta Blockers

Examples: Propranolol (Inderal), Metoprolol (Lopressor)

🫀 What they do: Beta blockers reduce the heart rate and the body's response to adrenaline. In POTS, this helps control the rapid heartbeat (tachycardia) that occurs when standing.

🩺 Why they’re used: Low doses can reduce symptoms like palpitations, anxiety, and fatigue without dropping blood pressure too much.

2. Fludrocortisone

Brand name: Florinef

💧 What it does: This medication is a steroid that helps your body retain salt and water, which increases blood volume and blood pressure.

🩺 Why it’s helpful: POTS often involves low blood volume. Fludrocortisone helps “fill the tank,” improving circulation and reducing dizziness or fainting when standing.

⚠️ Note: You’ll usually need to increase salt and fluid intake alongside this med for best results.

3. Midodrine

Brand name: ProAmatine

⬆️ What it does: Midodrine is a vasoconstrictor—it tightens blood vessels, helping raise blood pressure and prevent blood from pooling in the legs.

🩺 Why it helps: By keeping blood from “sinking” down to your lower body when you stand, it supports brain and heart circulation, easing symptoms like dizziness and fatigue.

⚠️ Important: It’s usually taken during the day only (not at bedtime) to avoid high nighttime blood pressure.

4. Ivabradine

Brand name: Corlanor (used off-label in the U.S.)

🫀 What it does: Ivabradine slows the heart rate without affecting blood pressure. It works directly on the heart’s electrical pacing system.

🩺 Why it’s helpful for POTS: For patients who experience a racing heart with minimal drops in blood pressure, ivabradine can provide relief without the fatigue that sometimes comes with beta blockers.

5. Pyridostigmine

Brand name: Mestinon

🔌 What it does: Pyridostigmine improves communication between nerves and muscles by increasing acetylcholine, a neurotransmitter.

🩺 Why it helps in POTS: It can help stabilize blood pressure and reduce heart rate, especially in patients with a lot of gastrointestinal symptoms or fatigue.

6. SSRIs or SNRIs

Examples: Sertraline (Zoloft), Venlafaxine (Effexor)

🧠 What they do: These are antidepressants that help regulate serotonin and norepinephrine—chemicals that also play a role in blood vessel tone and autonomic nervous system function.

🩺 Why they might be used in POTS: For some people, they help with nerve sensitivity, blood pressure regulation, anxiety, and brain fog.

⚠️ These are not used to treat depression in this case, but for their autonomic effects.

7. Droxidopa

Brand name: Northera

⚡ What it does: Droxidopa is a synthetic amino acid that converts into norepinephrine, a neurotransmitter that helps tighten blood vessels and increase blood pressure.

🩺 Why it might be used in POTS: Helps reduce dizziness, brain fog, and fainting by improving blood flow to the brain and stabilizing standing blood pressure—especially in patients with low BP or blood pooling.

⚠️ Often used when other medications like fludrocortisone or midodrine aren’t enough. Can cause supine hypertension, so not typically taken before bed.

8. Methylphenidate

Brand names: Ritalin, Concerta

💥 What it does: Methylphenidate is a stimulant that increases dopamine and norepinephrine levels, helping with alertness and focus.

🩺 Why it might be used in POTS: Can help combat fatigue, brain fog, and sometimes improve blood vessel tone. It may also slightly raise blood pressure and reduce orthostatic symptoms.

⚠️ May increase heart rate or anxiety in some people—used cautiously, especially in those with high resting HR.

9. Low Dose Naltrexone (LDN)

Dose: Typically 1.5–4.5 mg (vs. 50 mg for addiction treatment)

🔬 What it does: At low doses, naltrexone is thought to modulate the immune system and reduce chronic inflammation by affecting endorphin production and microglial cells in the brain.

🩺 Why it might be used in POTS: Emerging research suggests LDN may help reduce pain, fatigue, and brain fog, especially in patients with coexisting fibromyalgia, EDS, or autoimmune components.

⚠️ Still experimental for POTS—not a first-line treatment, but promising for some.

10. Modafinil

Brand name: Provigil

⚡ What it does: Modafinil is a wakefulness-promoting agent that affects dopamine and other brain chemicals to enhance alertness and cognitive function.

🩺 Why it might be used in POTS: Helps with excessive fatigue and brain fog, particularly in those whose symptoms interfere with daily functioning or work/school.

⚠️ May cause increased heart rate or anxiety, so it’s used with caution in POTS patients with extreme tachycardia.

11. Clonidine

Brand name: Catapres

🧘 What it does: Clonidine is an alpha-2 adrenergic agonist that decreases sympathetic (fight-or-flight) nervous system activity, leading to lower norepinephrine levels and a calming effect on the cardiovascular system.

🩺 Why it might be used in POTS: Used in hyperadrenergic POTS, where adrenaline is too high. Helps lower elevated heart rate and blood pressure, and reduce symptoms like anxiety or sweating.

⚠️ Can cause fatigue or low blood pressure in some people.

12. Methyldopa

Brand name: Aldomet

🧠 What it does: Methyldopa also works as a central alpha-2 agonist, decreasing nerve signals that tighten blood vessels and reducing overall sympathetic tone.

🩺 Why it might be used in POTS: Like clonidine, it's sometimes used in hyperadrenergic POTS to calm the nervous system and reduce adrenaline-related symptoms.

⚠️ Not commonly used as a first-line drug. May cause drowsiness or low BP in some patients.

A Few Important Notes

📝 POTS is complex, and not everyone needs medication. Many patients manage symptoms through:

• High salt and fluid intake

• Compression garments

• Physical therapy

• Dietary changes

• Sleep and stress management

  
  

💡 Medications are often used in combination and carefully adjusted based on symptoms, blood pressure, and heart rate.

Always work closely with your doctor to find the right medication plan for you.

Final Thoughts

Living with POTS can be exhausting and unpredictable—but the right combination of strategies, including medications when needed, can dramatically improve quality of life.

Don’t lose hope if the first treatment doesn’t work—sometimes it takes trial and error to find your ideal mix.

📌 If you’re just starting out, or if you’re feeling overwhelmed, know this: you are not alone, and there are options out there to help you feel better.

Have you tried any of these medications for POTS? What’s worked for you? Share your story in the comments—it might help someone else navigate their path!