Table 3.

Therapeutic proposal for orthostatic intolerance and intended effects (71, 73).

Treatment	Mechanism
Non-pharmacologic
Increase water and sodium intake	Avoids hypovolemia
Compression and physical countermaneuvers	Reduces venous pooling
Physical exercise training, including gradual resistance and lower extremity resistance training	Improves physical deconditioning and reduces venous pooling
Pharmacologic
Propranolol: 10 mg 1–3 times/day	Reduces standing heart rate and improves orthostatic symptoms, especially in hyperadrenergic patients with POTS
Midodrine: 2.5–15 mg 2–3 times/day (3–4 h before going to bed)	Reduces venous pooling and orthostatic hypotension, especially in neuropathic patients with POTS. Patients should be advised not to lie flat for at least 4 h after any dose of midodrine to avoid supine hypertension
Pyridostigmine: 30–60 mg 2–3 times/day	Reduces orthostatic tachycardia and improves chronic symptoms without worsening supine hypertension. Use should be limited in case of diarrhea, abdominal cramps, pain, nausea, urinary frequency and urgency
Fludrocortisone: 0.05–0.2 mg once/day	The effect only lasts 1–2 days, avoid prolonged use due to renal and cardiac involvement
Ivabradine: 5–10 mg	Reduces heart rate without affecting blood pressure
IV fluid therapy (saline)	Improves symptoms quickly although the effect lasts a short time. It is considered a bridging therapy
Others: - Droxidopa 100–600 mg 3 times/day (3–4 h before bedtime) - Atomoxetine 10–18 mg 2 times/day