Table 1.

General approach to management of orthostatic intolerance syndromes, POTS and Long Covid POTS

Principle	Example
Multi-disciplinary team management	Primary and secondary care clinician, specialist nurse, psychologist, physiotherapist, occupational therapist, social worker, social prescriber
Patient education and health promotion	Patient support websites and apps Social prescribing Gentle paced exercise retraining groups Enabling self-management at home using apps, blood pressure monitoring and symptom diaries Setting expectations for living with chronic disease
Holistic management incorporating principles of integrative care	Support groups encouraging peer support and a sense of community Breath retraining Structured rehabilitation programmes
Reducing lower body venous pooling	Lifestyle: fluid and salt repletion, compression garments, isometric counter-pressure manoeuvres Pharmacotherapy: fluid expanders (e.g. fludrocortisone) and α-receptor agonists (e.g. midodrine) to promote splanchnic vasoconstriction
Managing reactive adrenergic response to orthostatic intolerance	Lifestyle: breath retraining exercises, meditation Pharmacotherapy: β-receptor blockers, ivabradine
Symptomatic management of symptoms suggestive of mast cell activation	H1-receptor and H2-receptor antagonists Mast cell stabilizing treatment