Treating POTS can be tricky, even with a treatment plan that is created by a highly experienced physicians. In my experience, the most effective treatments for POTS syndrome are those that don’t require prescription medication – often referred to as natural, homeopathic, or lifestyle treatments. In some circumstances, patients also gain relief by supplementing a lifestyle-driven POTS treatment strategy with various medications. In this article, you’ll find an exhaustive list of treatment options available for POTS, all of which have been proven effective in peer-reviewed medical publications. Many of our readers have found it helpful to share this resource with their physician. If that helps you get on the right track for relieving POTS symptoms and regaining control over your life, feel free to use this resource in any way that’s helpful. Also, be sure to checkout the infographic below that explains primary treatment methods in an easy-to-understand format.
Treatments for POTS That Don’t Require Medication
These are things such as compression stockings that compress the legs and help prevent pooling of blood in the lower extremities. Effective stockings are likely to be full length to the waist, rather than those that are just knee high. The degree of compression that is most effective will be at least 30mmHg.
The importance of attention to diet in POTS Syndrome is covered in this separate linked article. But let’s briefly let’s discuss some of the important points here. Initially, the diet will center on increasing fluid and salt intake to increase circulating volume. Lower carbohydrate and smaller sized meals are also recommended to prevent pooling of blood in the stomach vessels. Some patients may be sensitive to caffeine and it should be limited, particularly if you suffer from hyperadrenergic POTS. Alcohol and energy drinks should be avoided, as they can worsen orthostasis and have been associated with triggering POTS episodes. Finally, those with GI symptoms should consider gluten and dairy intolerance. By cutting these things out of your diet in a “trial”, you’ll eb able to see if they’re having an impact.
Exercise is generally recommended for all POTS patients and is a key part of any treatment strategy. Physical deconditioning is an important aspect of POTS and can worsen symptoms. This deconditioning has been highlighted by studies that show POTS patients have lower oxygen uptake during exercise compared to healthy individuals (Parsaik et al). POTS patients also have smaller heart chamber sizes and lower heart muscle mass, likely resulting from less activity (Fu et al). Importantly, studies have shown that endurance exercise training is an effective treatment for POTS and can result in substantial improvement in symptoms (Shibata et al). Exercise can increase cardiac and skeletal muscle mass, and improve overall cardiovascular fitness. This in turn will improve the body’s ability to cope with standing, and other stressful situations in POTS.
Exercise may be challenging for two reasons. Firstly, patients feel too tired to exercise, andsecondly patients may feel fatigued and more symptomatic after exercising, often lasting days. Despite this, it has been proven that even if done slowly, and time taken to build up the exercise level, there will be significant improvement. The fact is that patients that exercise are likely to do better then those that don’t. You can find a more comprehensive discussion of the importance of exercise for patients with POTS Syndrome here.
Fluid intake has been shown to decrease the chances of feeling faint in response to standing and has been proven to be of benefit in patients with orthostasis (Shannon et al). Dehydration should be avoided and will almost certainly worsen symptoms of POTS Syndrome. In general, POTS patients should aim to have >2 liters per day. At times of dizziness, drinking 2 glasses of water over a few minute period may help to raise blood pressure and improve symptoms. I’ve written a complete article discussing the important role of hydration for POTS patients.
When we stand, due to the effects of gravity blood tends to pool in the lower extremities. In POTS, the normal mechanisms that counter this are dysfunctional resulting in reduced return of blood to the heart and the upper body leading to dizziness. It has been proven, that in some patients, tensing of the leg muscles when standing can stabilize the circulation and improve orthostatic intolerance. (Van Lieshout et al).
Symptoms of POTS may have significant impact on quality of life and things that are taken for granted by many now become a challenge. Simple routine changes may be helpful. Often POTS patients have worse symptoms in the morning, and it may be advisable to schedule events in to the afternoon. Things such as taking extra time to stand up, and also sitting down in the shower may be helpful. When symptoms are prominent such as dizziness or a faint feeling, it is wise to lie down and elevate the legs to minimize risk of trauma in the event of almost passing out or passing out.
Increasing Salt Intake
The role of salt in the treatment of POTS is covered in detail in the diet section. With the exception of kidney/heart failure patients, most doctors would recommend an effort to increase dietary salt for POTS patients, usually by around 2-4g/day. If the doctor devising the treatment plan feels it is necessary, some POTS patients may benefit from up to 6-8g sodium/day. Initially, there should be an attempt to increase salt by means of dietary salt, although if necessary as per the treatment plan salt tablets may need to be used.
Prescription Drug Treatments for POTS
A number of medications have proven to be effective at treating POTS Syndrome, although the effectiveness of a given medication can be affected by the type of POTS Syndrome diagnosed. Below you’ll find a list of the medications found to be effective for treating POTS symptoms, along with citations of relevant studies.
Benzodiazepines are the class of drugs that include Klonopin and Xanax. They are anti anxiety agents. There is some evidence that in patients with some forms of neutrally mediated passing out spells that Klonopin may have some benefit (Kadri et al). The evidence is limited though and certainly not conclusive. Benzodiazepines should be used with extreme caution and if possible avoided, as they are highly addictive and may result in dependence. They are certainly not first line treatment for POTS patients.
Beta blockers, mainly propranolol, are used fairly frequently in POTS. Basically beta-blockers are a drug that primarily reduces heart rate. It has been shown that propranolol may be helpful in reducing heart rate and improving symptoms in POTS patients. This benefit was only seen with low dose propranolol (Raj et al). It is felt that the beta blockers may prevent the heart rate getting to high in exercise and this may improve symptoms. One study showed that low dose propranolol was associated with increased exercise capacity (Arnold et al).
Clonidine is a drug that controls some of the nerve responses from the brain. It is usually used to control high blood pressure but has been found useful in many conditions and may have some use in certain patients with POTS. It can be particularly useful in those with hyperadrenergic POTS (Raj et al). In some patients clonidine may be effective to control heart rate and blood pressure. Unfortunately clonidine can cause fatigue and mental clouding in some patients.
One of the treatments of POTS is increasing blood volume that may lead to reduced symptoms such as dizziness and allow the body to adapt to standing better. Desmopressin basically stops the kidneys from releasing water in to the urine and keeps it in the body. Research shows that at least in the short term desmopressin may control heart rate and improve symptoms in some POTS patients (Coffin et al). The use of desmopressin is associated with side effects such as swelling and headaches. Also there may be derangements of blood sodium levels and so a prescribing physician should carefully monitor its use.
Erythropoietin is a hormone produced by the kidney that controls the production of red blood cells. There has been research showing that red blood cell volume may be low in POTS. Some studies have demonstrated that in patients that do not benefit from more common treatments, erythropoietin may result in improvement in POTS symptoms, particularly orthostatic intolerance (Kanjwal et al). In those taking erythropoietin, usually as an injection, regular blood tests are required to ensure the level of blood cells doesn’t get too high.
Fludrocortisone is a synthetic type of steroid that can cause the body to retain salt and therefore water. Basically it can be useful in POTS because it increases circulating volume and can therefore alleviate some of the symptoms of POTS and improve the body’s response to standing. Studies (Freitas et al) and experience from treatment centers (Grubb et al), suggest that fludrocortisone may be particularly useful in POTS patients suspected of having a low blood volume, if used as part of a supervised treatment plan.
Ivabradine is a drug that acts on the heart to slow down heart rate. In contrast to other drugs that do this, Ivabradine slows down heart rate without affecting blood pressure. A few studies suggest that Ivabradine may be useful in POTS to improve orthostatic intolerance and prevent the heart rate rising too high (Mcdonald et al). As with many POTS drugs, good controlled trials are required before it’s use can be recommended widely.
One of the causes of POTS is pooling of blood in the lower body partly because the blood vessels in the legs relax too much. Midodrine causes the vessels to constrict thus preventing pooling and also leading to an increase in blood pressure. (Hoeldtke et al). Unfortunately its use is often limited by side effects that include tingling and headaches.
Octreotide is a drug that can cause tightening of the blood vessels and therefore improve the tolerance to usual POTS stressors such as standing up. It may be particularly useful in those with gastrointestinal symptoms such as nausea and delayed gastric emptying. Octreotide has been shown to reduce heart rate in POTS patients also (Hoeldtke et al).
Pyridostigmine is a drug that prevents breakdown of a nerve transmitter known as acetylcholine. It is usually used in an autoimmune condition called myasthenia gravis condition in which antibodies cause weakness. In some forms of POTS, Pyridostigmine has been demonstrated to prevent increase in heart rate and improve symptoms (Raj et al). Unfortunately the use of Pyridostigmine in POTS may be limited by side effects such as constipation.
Selective Serotonin Uptake Inhibitors (SSRI’s)
SSRI’s are a class of drug typically used as antidepressants. The production of serotonin is thought to be faulty in some patients with fainting spells and there has been some experience to suggest it may be of use in some with neuro-circulatory passing out such as that seen in postural orthostatic tachycardia syndrome (Goldstein et al).
ion water cooler says
Your style is unique compared to other people I’ve read stuff from.
Thanks for posting when you have the opportunity, Guess
I will just book mark this site.
Thank you for the post. I was able to find what my problem has been all these years. No doctor has ever diagnosed my issue. Now I know and I’m very grateful to you. I hope you’d help raise awareness about this syndrome among family doctors.
Mom of pots kid says
This article does not diagnose POTS. You need to go see a nurologist if you are having symptoms of POTS.
Or an EP Cardiologist.
Terrie Lou Letourneau says
I do agree I have all the symptoms of POTS and I still could have it. But they ran some special tests and come to find out I have a severe case of lead poisoning. Hyperthyroidism and deteriorating bones and highly anemic. Deficiencies of sever very important vitamins and nutrients. Iron being a big one. Chelation treatments and infusions will start next week. I was told to stop taking my heart meds by my cardiologist. Please check things out like this first. Especially when it involves the heart and fainting. Good luck everyone.
please get tested for Lyme disease! Everything you arersaying fits with chronic lyme. only 50% of people realize they’ve been bitten. the routine dr blood tests for lyme (western blott and Elysia) are know for false positives and are unreliable. The only reliable test is done through a lab called IGENEX. Please get tested!
There are 100s of illnesses that have all of these symptoms. Getting a dx is a trial and error thing….like most things are.
Dawn Smith says
Yes!! I have chronic Lyme disease and these symptoms are also present with me. I’m not sure what to do? However I don’t have all of these.
John Bedson says
study the NASA 10 minute Lean Test and you can diagnose yourself to a certain extent.
I appreciate the information.
This information has been very helpful to me.Thank you!
I have dealt with Pots for the last 8 1/2 years, and have kept up with all treatments and medications used for Pots patients since then. Your information was a pleasant surprise as I have not heard of several of the medications mentioned above. I look forward to showing the information to my doctor and seeing if they can be helpful in my particular case.
My daughter I s13 and recently has been having these symptoms which landed us in the ER!! She almost passed out on several occasions and the last one after speaking to her pediatrician we decided the ER was best after all her blood work was normal. The ER diagnosed her with possible POTS, we have a cardiology Appt. on Friday 2/24/17. Is there anything I should ask or any particular things I need to be aware of when we go? Thanks this website was very helpful.
ask for a tilt table test. It’s the best way to k sonic it’s really P.O.T.S Syndrome. Also I have lots I do not have the type that requires salt infact i have the the type that needs less salts
I am curious about the long term consequences from the tachycardia. I was diagnosed 5 years ago and have not improved with treatments. My HR is 130 after walking 15 steps to 200 if I continue for less than 5 minutes. Is this causing long term damage?
It can, are you taking anything to regulate your heart rate? If you have been taking the regular medications like Propranolol etc then it may be an idea to see a Cardiologist about getting a pace maker these have been known to work for many patients who have this. My daughter unfortunately has the opposite happen where she gets low blood pressure and passes out. They can’t seem to get it under control. The pace maker was mentioned to us by a nurse but her heart rate is under control and stays at the normal rhythm.
Dr. Randy Martin says
Please note that a pacemaker will not treat this condition if the heart rate is already fast. Pacemakers ARE useful in certain patients if their heart rate is too LOW, causing symptoms. A pacemaker cannot slow the heart down – it just keeps it from GETTING too slow by speeding it up to a pre-set level, usually 60 beats per minute.
How do I find a doctor anywhere local to get help for this..the man I love has a bad case of Potts an we can’t seem to find anyone familiar with this so he’s not getting any help.it continues to grow worse on him..if absolutely anyone can help me feel free to email me any info possible.. [email protected]..you have no idea how greatly I would appreciate the assistance..
C Welch says
There are two U T Physicians in the Houston Medical Center specializing in this area (Dysautonomias). Their names are Dr Mohammed Numan, an Electrocardiophysiologist, and Dr Ian Butler, Neurologist. They are both pediatric physicians, however, in the area of the dysautonomias they are also researchers, and as such, have accepted many adult patients of all ages in their dysautonomia research program–my 34 yr old daughter being among them. There are some patients many years older than her. See U T Physicians website, and search Dysautonomia.
The Drs are typically extremely booked, and am not sure if they are accepting ‘new’ patients, but it’s worth a try. They or their office might be able to refer you to others who are adept at treating POTS/the dysautonomias. I think the Mayo Clinic in Wisconsin (?) also has a team that treats/researches in this area. You might have to be willing to travel. At least call for any references they might also be able to share. Good luck!
Item #3 says more salt.
If low blood volume is an issue, has any research been done in regards to bone marrow transplantation?
I have been searching for an answer as to why I am so exhausted, can hardly move or do much of anything without then sitting down and resting, have constant shortness of breath, dizziness, and so much more. My doctors all know that I was diagnosed with POTS six years ago but none of them have suggested that this could be the cause of my health issues? I had to look up “why my pulse is always so high,” that led me to this site to learn for myself a very possible answer? It’s so sad to say that so many doctors today just can’t be bothered to even read the medical information that the patients are required to fill out, sometimes taking us 20-30 minutes before our appointments. I have found so many doctors these days that aren’t even willing to spend even 5-6 minutes talking with me. They can be abrupt, rude and condescending. Not all doctors are this way but, sad to say, it has become more common than in the past. Thank you so much for publishing this excellent, well-written, informative, and easy to understand article on POTS.
Sandra Gurrola says
Donna, I have found the same problem with doctors. I can’t seem to get any help, and the pounding heart and dizziness is very disabling. I wish you luck.
Esmeralda Gray says
Same as well, I’m 13 and was diagnosed a couple of years ago after I fainted. my mom did nothing and still doesn’t, in fact, she forgot about it! It’s very frustrating no doctors really seem to care. I have a diagnosed chronic headache and migraines and only after I started to research to convince my mom to let me get a chair (wheelchair) did I find out this could be the cause. I experience a long list of symptoms related to POTS and they are very bad. examples include: I can’t stand in the shower without almost fainting, walking long distances makes me very tired and dizzy, etc. I have had a long list of health problems and only now did I find out they are all related! All my mom does is tell me to drink more water. No doctors seem to mention anything about it even after they bring it up.
Teri Sims says
This is terrific information!! As an RN I have read as many POTS articles as I can. My cardiologist says my BP is sensitive. I’m definitely going to talk to him about the possibility of me having POTS due to all my symptoms. For other patients, I want to express the importance of documentation of your symptoms. I have been doing this for two years and my Dr was very happy and even copied my journal.
My daughter had Viral Meningitis Nov 2016 at age 13. We never imagined the roller coaster following this illness. Nearly a year later, headaches every day almost, nausea, faint, heart racing, ect. Completing a full day of school is a challenge. Recently, sje was diagnosed with POTS. Finally, we can understand after seeing the diagnostic test showing her heart rate doubles along with a sky rocket of her BP to 170’s/90-100. Now we are just seeking how we can learn to manage a higher quality of life. This is the age she should be enjoying.
My daughter has a d-loop in her heart now. At 32 she can’t work, can’t drive, can’t be left alone due to dizziness and fainting where her BP rises to 180/110 which is a stroke risk.. meds, diet, excercise isn’t working.. I’m so damn angry with Drs. One says more salt another says no, excercise omg she can’t hardly stand for long how can she excercise? She tells me she is afraid one day she won’t wake up and I don’t know that she isn’t saying the truth.. where do we turn next?
Tandi Caldwell says
Try contacting Dr. Blair Grubb at the University of Toledo. There is also the Mayo Clinic, The POTS Treatment Center in Texas, Vanderbilt has Autonomic Specialists. There is also an at home program you can look into, founded by Annie Hopper. It is called Dynamic Neural Retraining System. The Facebook group, Neural Retraining Friends can direct you more on that. It sounds like your daughter could use inpatient care since she is certainly deconditioned like me. I am having to start with 30 seconds of bed yoga on YouTube videos and THAT is hard! I have had POTs and Neurocardiogenic Syncope since I was 19 and I am 42. I had 8 good years in the middle and menopause is flaring it now. I am getting a port for infusions at home. Dr. Grubb is a lifesaver! I wish your daughter well. You have every right to be angry. It is no life to live and the funding isn’t there. Thankfully, there are sites like these and FB groups that help us find our own doctors and PubMed papers and go in and fight to be heard. Also look into 23andme.com testing and Lyme testing. Learn the optimal values for vitamins and minerals. Most “normal” labs are not optimal, a huge difference. Good Luck!
Harriet Glazer says
My daughter is the same age, married , with two small children. How do you help an adult child? We live in different states and she can’t even get out of bed. She is seeing a cardiologist in LA now but I see no improvement. I feel so totally helpless
Look into the DNRS neural retraining program. They’ve had success with POTS.
My adult son also recently has been diagnosed with POTS. He just took a new job and is moving to Boston. He is afraid he won’t be able to work at his new job because this is quite disabling. He had the tilt table test and his bp is okay but his heart rate jumps up when he goes from laying down to standing. He is scared. He spent 6 years in college to get a good degree to be successful and now he can barely get out of bed! Is your daughter improving?
There is a testing program at Beth Israel Deaconess Hospital in Boston. I waited 5 months to get in and went for testing yesterday. Your son may be able to find a dr there who works on this. I go back in October to see them for an evaluation and I’m hoping they have some ideas then.
Maria lopez says
This is definitely very tough to deal with I consider myself a professional working hard to raise my 3 daughters and keep up with my married life, i have been battling this for 4 years and it only seems to be getting worse so bad I cannot get out of bed. Doctors do not seem to care Everything is money and funds are not enough so what do we do? I have found a few places like plasticity brain center that say they can help but had anyone really gone through this treatment program and has it helped? They are asking 10k cash and say they can help. Anyone?
You can do limbic system retraining at home for around $250. Look up Dynamic Neural Retraining System (DNRS) online. There are lots of POTS recovery success testimonials.
Paula Webb says
Great article! It really empowers people to take control of their POTS naturally. These simple measures can really help some POTSies. I have been working successfully with a patient here in the UK who came off her medications and is now just using homeopathy and the protocols you list above. She’s doing really well!
Ready your post dated 11 13 17 about patient you are/were treating in UK. You mentioned she used homeopathic methods, items. Could you tell me what she used. I would rather go natural then take man made drugs. I have more medical issues than POTS so my drs. want me on more meds. For example, nausea they’ve given me a medication to take, but medicinal cannabis helps for that and my lack of appetite.
cindy cormier says
my daughter has been diagnosed with POTS, but still doing more tests. seeing doctors in Boston area, but very frustrating trying to get an appointment. her primary care doctor is not much help either. please tell me what doctors to turn to for help, we find that there are not many doctors that specialize in this, or that don’t take new patients
Alyssa Packer says
I am 16 years old and was diagnosed with POTS recently. I went to a place called Advocate Childrens hospital. The pediatric Cardiologist I saw was able to explain things to my mother and I and we are starting a new treatment plan soon. You can get hod of them on their website I believe.
I know how frustrating it can be with doctors not knowing what to do or are not willing to help. My only advice is to get the compression socks, wear them everyday, drink more water than usual, and to increase your salt intake. This will not completely help your daughter, but enough to keep her going while you wait for an appointment.
Good Afternoon everyone,
I to have POTS and some days its hard for me to get up and go to work.
my question is, is there any article or study that shows significant weight loss would help the condition?
I have pots and several autonomic issues as well. However I see a nephrologist not a cardiologist for my pots. My doctor seems to have a better understanding of how pots works. Perhaps this may help until you can find a autonomic specialist?
I have pots with the the orthostatic postular tachycardia but I also have orthostatic postular hypotension. Is it normal to have both? And yes doctors are endlessly frustrating. I just waited months to see a cardiologist who then told me he didn’t know what pots was. Idiot.
Dave M says
It is tough working with the medical community. I am on doctor 28 since I started with POTS. I live in the Intermountain West. There is precious little expertise here with POTS eight years ago. But doctor 22 was the first to which I presented BP data that can be reproduced in the exam room. Basically, I did the NASA 10 Minute Lean Test in my home everyday for two weeks, along with recording hydration data (quantity fluid drank, urine color). Once I presented that data, there were no more looks askance in my direction. The system started working for me. I suddenly went from a hypochondriac or mental patient to a man with a “real” problem. Granted, most doctors still do not know what to do about wacky orthostatic BP and pulse numbers, but at least I get respect. Now my main trouble with the doctors is forcing them to think outside their box when all they want to do is throw up their hands. At a minimum, I make them answer one question, “What’s next?” Usually, they actually come up with a helpful reply or even a referral. But I do have to ask.
I would like to know if its better to see an cardiologist or an neurologist? Everywhere I read cardiologist but as far as I get it, its a neurological disease… can someone explain to me please?
Thanks in advance
Maria lopez says
Hello Sue ive been to both and they are both aware of the condition but both having a hard time getting it treated. I will however say the cardiologist seems to have more alternatives on the meds and testing.
Hello, I was diagnosed with POTS in March of this year. My been having these same symptoms for over 5 years now but I’ve been treated for anxiety. My doctors only treat the symptoms but really don’t have a clue about POTs. POTS been a syndrome for decades and I can’t believe they don’t have a better solution to our issues. This syndrome is veey serious and disabling at times. Most people I ask about this have no clue what it is. I believe it should be taking more seriously. I’m from St. Louis and I’m hoping Washington University hospital will have a solution for me. It can cause depression and it have increased my anxiety. I pray before I start my day and eat lightly and take my medication that was prescribed. I can’t do a lot of exercise but I mainly do leg tightening. I was told by building tightening of the muscles in my calf it will help with blood flow. I get most my information off the internet. I been teaching myself since I received this disturbing news. I wish the best for you all and I pray we all overcome this illness. Have a bless day.
Maria lopez says
Thank you sandy, hope things can improve for you, any updates on how you are doing?
It’s December 2020 and I haven’t gotten any other treatments nor help this disease. It comes and goes for the most part. I just pay attention to my body and I can tell if I’m doing to much or eating the wrong things. I had to give beef because it irritates the digestive system. I’ve tried a high fiber diet. But I can say I’m doing better than I were these past years. I just learn to pay more attention to my boby wants and needs and get plenty of rest. Thank you
Karen Houston says
I was diagnosed with Myasthenia Gravis in 2014, 2 years after they removed a tumor on my thymus. It’s been an okay road. Had one flare which put me in the hospital 4 years ago and this previous year I have been in and out of the hospital trying to see which treatment can get me back feeling 100% again. Pyridostigmine bromide just makes me nauseous all day and didn’t help my droopy eye or swallowing so I need to try something else which was natural herbs recommendation from multivitamincare. org This herbal treatment has successfully cure my MG and am 100% free ,I completed the herbal treatment program last year December and am very delighted i came across their website.it starts in the eyes and face then bulgar muscles , without treatment or the proper dosages of treatment it goes on to my limbs and then neck and breathing muscles but I can happily say that am free from MG after taking my chances to try natural herbs ,my neurologist was surprise after my result of being totally cured with herbal cure from the org.
Hello, I have just been diagnosed with POTS and most of my symptoms seem to fit. One thing I wanted to ask others, is how severe the shortness of breath is for you? I feel like I am heavy breathing constantly, even while laying down at rest a lot of the time. I just always feel short of breath. I wake up in the morning short of breath too, which leads to panic attacks and tachycardia. Is this common for POTS? I ah e brought it up with my doctor many time and cardiologist, but neither proved any insights. I am wondering if other with POTS also experience this, or if I might have something else going on as well.