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

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 P...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2023-05, Vol.15 (5), p.e38887-e38887
Main Authors: Vasavada, Advait M, Verma, Deepak, Sheggari, Vineetha, Ghetiya, Srushti, Chirumamilla, Punith Chowdary, Kotak, Radhika A, Mahapatra, Shruti Sagar, Patel, Tirath, Jain, Manisha
Format: Article
Language:English
Subjects:
Autoimmune diseases
Beta blockers
Bias
Bibliometrics
Blood pressure
Cardiac arrhythmia
Cardiology
Chronic fatigue syndrome
Clinical trials
Connective tissue diseases
Drug therapy
Heart rate
Internal Medicine
Nervous system
Observational studies
Quality of life
Systematic review
Therapeutics
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Summary: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.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.38887