Table 1.

Therapeutic management of POTS.

Non-pharmacological treatments (10, 13, 83, 87–90)
Water intake: 2–3 l/day Oral NaCl intake: 10–12 g/day 20–40 mm Hg compression garments; focus on the abdomen and legs Sleep in a head-up tilt position (>10°) Drinking water before getting up in the morning Exercise training: semirecumbent with simple isometric, aerobic, and resistance exercises (84) Avoid situations that may exacerbate symptoms: sleep deprivation, exposure to heat or hot environments, alcohol intake or large meals, prolonged standing, anemia, and dehydration (17) Educate patients that POTS is a dynamic disease and that infections can significantly impact the disease trajectory (128) Moving carefully from a lying or sitting to a standing position (129) Counterpressure maneuvers: crossing legs (130) and squeezing thigh muscles, clenching buttocks, and tightly folding arms are useful to activate the skeletal muscle pump to increase venous return and prevent syncope Small frequent meals and fewer refined carbohydrates are recommended for glycemic balance and to avoid postprandial hypotension (131) It is advisable to regulate activity to achieve adaptive goals and to reduce the severity of flares and fatigue (11)
Pharmacological treatments (91–103)
Fludrocortisone 0.1–0.2 mg/daily Desmopressin 0.1–0.2 mg Erythropoietin 10,000 IU/weekly Propranolol 10–20 mg up to 4 daily Ivabradine 2.5–7.5/12 h Pyridostigmine 30–60 mg up to 3 daily Midodrine 2.5–15 mg 3 per day Octreotide 10–30 mg intramuscular Droxidopa 100–600 mg/8 h Methyldopa 125–250 mg/12 h Clonidine 0.1–0.2 mg orally o patch Intravenous immunoglobulin and plasmapheresis
Non-invasive neuromodulation (104, 105)