Melatonin Reduces Tachycardia in Postural Tachycardia Syndrome: A Randomized, Crossover Trial

• Published in: Cardiovascular therapeutics 2014-06, Vol.32 (3), p.105-112
• Main Authors: Green, Elizabeth A., Black, Bonnie K., Biaggioni, Italo, Paranjape, Sachin Y., Bagai, Kanika, Shibao, Cyndya, Okoye, Mirian C., Dupont, William D., Robertson, David, Raj, Satish R.
• Format: Article
• Language: English
• Subjects: Administration, Oral; Adult; Anti-Arrhythmia Agents - administration & dosage; Anti-Arrhythmia Agents - therapeutic use; Autonomic nervous system; Blood Pressure - drug effects; Cross-Over Studies; Drug Administration Schedule; Drugs; Female; Heart Rate - drug effects; Humans; Male; Melatonin; Melatonin - administration & dosage; Melatonin - therapeutic use; Norepinephrine - blood; Orthostatic intolerance; Postural Orthostatic Tachycardia Syndrome - diagnosis; Postural Orthostatic Tachycardia Syndrome - drug therapy; Postural Orthostatic Tachycardia Syndrome - metabolism; Postural Orthostatic Tachycardia Syndrome - physiopathology; Sympathetic nervous system; Sympathetic Nervous System - drug effects; Sympathetic Nervous System - metabolism; Sympathetic Nervous System - physiopathology; Tachycardia; Tennessee; Time Factors; Treatment Outcome; Young Adult
• ISSN: 1755-5914; 1755-5922
• DOI: 10.1111/1755-5922.12067

Summary Background Postural tachycardia syndrome (POTS) induces disabling chronic orthostatic intolerance with an excessive increase in heart rate (HR) upon standing, and many POTS patients have a hyperadrenergic state. Medications that restrain HR are a promising approach to this problem. Objective We tested the hypothesis that melatonin will attenuate the tachycardia and improve symptom burden in patients with POTS. Methods Patients with POTS (n = 78) underwent acute drug trials with melatonin 3 mg orally and placebo, on separate mornings, in a randomized crossover design. Blood pressure, HR, and symptoms were assessed while seated and after standing for up to 10 min prior to, and hourly for 4 h following study drug administration. Results The reduction in standing HR was significantly greater 2 h after melatonin compared with placebo (P = 0.017). There was no significant difference in the reduction of systolic blood pressure between melatonin and placebo, either with standing or while seated. The symptom burden was not improved with melatonin compared with placebo. Conclusion Oral melatonin produced a modest decrease in standing tachycardia in POTS. Further research is needed to determine the effects of regular night‐time use of this medication in POTS.