T.R.E.A.T.M.E.N.T
**Treatment is subjective and varies with experience of every doctor**
It is unique and specific to the patient...
trial and error is often used
POTS
- Increased Fluid Intake: Every POTS patient should consume at least 3L of electrolyte enhanced fluids per day, regardless of their individual symptoms.
- Jobst Stockings/Support Stockings/Abdominal Binder: Some patients claim that these help with vasodilation in the legs and promote vascular constriction, to help with the blood pooling. These can be obtained from a medical supply store (and often covered by insurance with a prescription from your doctor).
- Increased Salt Intake/Salt Tablets: Adding extra salt to the diet can assist with increasing both blood pressure and blood volume by increasing fluid retention. Salt tablets may be used if not enough salt can be obtained with diet/fluids. *Note, that a high sodium diet should only be practiced with approval from your doctor
- Midodrine: Also known as ProAmitine, is one of the most popular/most used alpha-agonists (which constricts blood vessels and promotes adequate blood flow). This medicine is usually only prescribed for patients with vasodilation issues and hypotension - it is also important that this medicine should not be taken before bedtime as it can cause supine hypertension.
- Florinef: Also known as fludrocortisone, is a steroid used to help the body retain salt and water, thus improving hypotension (low blood pressure). This drug also can also have a vasoconstricting effect to help with blood flow.
- Mestinon: This drug is traditionally known for treating myasthenia gravis, but is now used for treating POTS by inhibiting the breakdown of acetylcholine. Acetycholine is the main chemical messenger for the parasympathetic nervous system. In some people, their immune system makes anti-bodies that plugs the connection, so mestinon works by repairing that connection.
- Beta-Blockers: The most commonly used drug is beta blockers. There are many different beta blockers on the market (Atenolol, Metoprolol, etc...) These are used to control tachycardia, but should be carefully monitored, as it also decrease the low blood pressure even more and can cause bradycardia(low heart rate). While these medicines can be helpful for tachycardia, it can exacerbate fatigue, weakness, and can be troublesome for those with asthma or breathing problems.
- SSRI: Selective Serotonin Re-uptake Inhibitors are most commonly known as anti-depressants, but for those with POTS, also work in a different way. These medicines are not used to treat patients for depression, but because serotonin is the principal neurotransmitter that the brain uses to govern autonomic control, in particular - blood pressure. Some patients may have disturbances in their serotonin production and regulation, so SSRI's may be beneficial for some patients.
