Choices and Challenges With Drug Therapy in Postural Orthostatic Tachycardia Syndrome: A Systematic Review

Abstract

The literature on pharmacologic treatments for postural orthostatic tachycardia syndrome (POTS) is inconsistent and unstandardized. Therefore, we aimed to evaluate choices in pharmacologic treatment options for POTS and the challenges encountered in the studies. We searched numerous databases like PubMed, Scopus, Embase, Web of Science, and Google Scholar for literature published before April 8, 2023. The search was done to retrieve potential peer-reviewed articles that explored drug therapy in POTS. Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were used to conduct the systematic review. Of the 421 potential articles assessed, 17 met the inclusion criteria. Results demonstrated that pharmacologic treatment options for POTS were effective in reducing symptoms of POTS, but most of the studies were underpowered. Several were terminated due to various reasons. Midodrine ivabradine, bisoprolol, fludrocortisone, droxidopa, desmopressin, propranolol, modafinil, methylphenidate, and melatonin have been studied with positive impact but sample sizes that were low in the range of 10-50 subjects. Therefore, we concluded the treatment options effectively improve symptoms of POTS and increase orthostatic tolerance, but more evidence is needed as most studies had a low sample size and thus are underpowered.

Keywords: drug therapy; orthostatic intolerance; postural orthostatic tachycardia syndrome; pots-all types; treatment.

Figure 1. Diagnosis of POTS

POTS: postural orthostatic tachycardia syndrome, bpm: beats per minute Source: Advait Vasavada (created with Biorender.com (Science Suite Inc, Canada), agreement number UE25C1X64H)

Figure 2. PRISMA chart

Created using the Shiny app by Haddaway et al. (2022) [14].

Figure 3. Traffic light plot highlighting the quality appraisal for the studies

Studies [7,15,17-24,26,29]