Table 2.

Therapies for exercise intolerance in low preload states and associated conditions

Nonpharmacological

Pharmacological

• Medication review • Adequate salt intake (10 g daily) • Adequate hydration (3–4 L daily) • Rapid water intake before activities • Head elevation at night (10°) • Slow postural changes • Avoid prolonged standing • Avoid warm environments • Over-the-knee/waist-high compression • Abdominal binders • Rebreathing training exercises • Exercise training (recumbent with slow progression to upright) • Counterpressure maneuvers for acute symptoms

To increase volume  • Salt tablets 1–2 g three times a day  • Fludrocortisone, 0.1–1 mg To increase sympathetic activity  • Midodrine, 2.5–10 mg three times a day Peripheral cholinesterase inhibitors  • Pyridostigmine, 30 mg two times a day to 60 mg three times a day To reduce tachycardia  • Propranolol, 10–40 mg three times a day  • Ivabradine, 2.5–7.5 mg two times a day Central adrenergic agents  • Droxidopa, 100–600 mg three times a day  • Methyldopa, 125 mg-250 mg two times a day  • Clonidine, 0.1–0.2 mg three times a day Agents for inflammatory/autoimmune conditions  • IVIG, 400 mg/kg/d for 5 d  • Rituximab, 1 g/kg for two infusions  • Plasmapheresis  • Corticosteroids, mycophenolate, azathioprine, cyclophosphamide in conjunction with above therapies Experimental agents  • Atomoxetine  • Octreotide  • Yohimbine  • Ergotamine  • Pseudoephedrine  • Caffeine  • Erythropoietin

Definition of abbreviation: IVIG = intravenous immunoglobulin.

Most of the presented treatments have been adapted from the management of patients with autonomic dysfunction.