Efficacy of Propranolol, Bisoprolol, and Pyridostigmine for Postural Tachycardia Syndrome: a Randomized Clinical Trial

Moon, Jangsup; Kim, Do-Yong; Lee, Woojin; Lee, Han Sang; Lim, Jong-Deock; Kim, Tae‐Joon; Jun, Jin-Sun; Park, Byeongsu; Byun, Jung-Ick; Sunwoo, Jae Gun; Jung, Keun‐Hwa; Park, Kyung‐Il; Jung, Ki-Young; Kim, Manho; Lee, Sang Kun; Chu, Kon

doi:10.1007/s13311-018-0612-9

Cited by 29 publications

(24 citation statements)

References 41 publications

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“…Symptoms and quality of life may improve with a supervised exercise program consisting of lower-extremity supine exercises. 3 Although no drugs are currently approved by the United States Food and Drug Administration to treat POTS, fludrocortisone, 10,11 pyridostigmine, 11,12 low-dose propranolol, 13 midodrine, 14 droxidopa 15 and β-blockers including bisoprolol 10,11 may provide some benefit. Clonidine and methyldopa can be considered in neuropathic POTS.…”

Section: Discussionmentioning

confidence: 99%

Acute Water Ingestion as a Treatment for Postural Orthostatic Tachycardia Syndrome

Ziffra

Olshansky

2019

J Innov Cardiac Rhythm Manage.

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A 24-year-old female presented to our clinic with symptomatic tachycardia. In the clinic, she was able to replicate her symptoms, which were due to tachycardia in a standing position that resolved upon sitting. The patient was then offered eight ounces (236.6 mL) of water and, after consumption of such, the standing tachycardia was no longer observed. A diagnosis of postural orthostatic tachycardia syndrome (POTS) was made. This case report discusses a novel approach to acute treatment for POTS.

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Section: Discussionmentioning

confidence: 99%

Acute Water Ingestion as a Treatment for Postural Orthostatic Tachycardia Syndrome

Ziffra

Olshansky

2019

J Innov Cardiac Rhythm Manage.

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“…37 Our systematic review identified 4 studies that evaluated beta blockers. 21,24,25,28 Metoprolol improved postural tachycardia in a study with 66 subjects and 66 controls. 21 Propranolol did not alter baroreceptor sensitivity.…”

Section: Beta Blockadementioning

confidence: 96%

“…[21][22][23][24][25][26] Two studies were randomized controlled trials. 27,28 Patients' ages ranged from 6 to 44 years, with relatively more females than males (range: 58%-95% females).…”

Section: Study Characteristicsmentioning

confidence: 99%

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Treatment of Postural Orthostatic Tachycardia Syndrome With Medication: A Systematic Review

et al. 2020

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Purpose: Postural orthostatic tachycardia syndrome has been recognized for decades, but treatment is largely based on anecdotal experience and expert opinion. Pharmacologic treatment is inconsistent and unstandardized. We did a systematic review to identify controlled studies from which informed treatment decisions can be made. Method: Through a standard systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we identified all English-language studies of a medication treatment for postural orthostatic tachycardia syndrome that included a comparison or control group and followed outcomes for at least 1 week of treatment. Results: A total of 626 studies were identified by the search criteria, and 8, involving a total of 499 patients, met the criteria. No studies were adequately similar to allow for meta-analysis. Of the identified 8 studies, 2 were randomized controlled trials and 4 had been subjected to peer review. In individual studies, there was some favorable effect with fludrocortisone, beta blockers, midodrine, and selective serotonin reuptake inhibitors. Conclusion: There is a paucity of high-quality data about effectiveness of medication in the treatment of postural orthostatic tachycardia syndrome. Nonetheless, 2 randomized trials and 6 other reports show some favorable effects of medication.

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“…Although several randomized controlled trials of relatively high quality may have provided physicians with reasons to consider treating adult POTS patients with β-blockers, it is not the case with children (8, 9). Inconsistent results have been published in recent years, most of which are non-randomized, or of small sample size.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of β-Blockers on Postural Tachycardia Syndrome in Children and Adolescents: A Systematic Review and Meta-Analysis

et al. 2019

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Background: Postural tachycardia syndrome (POTS) is a severe health problem in children. Short-term β-blockers are recommended for pharmaceutical treatment. However, there have been contradictory data about its efficacy among pediatric patients.Methods and Results: Eight studies comparing β-blockers to conventional treatments for children with POTS were selected, where 497 cases of pediatric POTS were included. The efficacy of β-blockers was evaluated using the effective rate, the change of symptom score, the change of heart rate difference and adverse events. The results were stated as relative ratio (RR) and mean difference (MD) with a 95% confidence interval (95% CI). A random-effects meta-analysis for the effective rate indicated that β-blockers were more effective in treating pediatric POTS than controlled treatment (79.5 vs. 57.3%, RR = 1.50, 95%CI: 1.15–1.96, P < 0.05). A fixed-effects model analysis showed that β-blockers were more effective in lowering the symptom score and the heart rate increment during standing test than controlled treatment with a mean difference of 0.81 (95% CI: 0.44–1.18, P < 0.05) and 3.78 (95% CI: 2.10–5.46, P < 0.05), respectively. There were no reported severe adverse events in included studies.Conclusion: β-blockers are effective in treating POTS in children and adolescents, alleviating orthostatic intolerance, and improving hemodynamic abnormalities.

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Efficacy of Propranolol, Bisoprolol, and Pyridostigmine for Postural Tachycardia Syndrome: a Randomized Clinical Trial

Abstract: NCT02171988.

Cited by 29 publications

References 41 publications

Acute Water Ingestion as a Treatment for Postural Orthostatic Tachycardia Syndrome

Acute Water Ingestion as a Treatment for Postural Orthostatic Tachycardia Syndrome

Treatment of Postural Orthostatic Tachycardia Syndrome With Medication: A Systematic Review

Efficacy of β-Blockers on Postural Tachycardia Syndrome in Children and Adolescents: A Systematic Review and Meta-Analysis

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