Midodrine 10mg tablets

Postural orthostatic tachycardia syndrome (POTS) is a condition defined by symptoms of orthostatic intolerance and a sustained heart rate (HR) increment of ≥ 30 beats per minute (bpm) upon postural change to the upright position in the absence of orthostatic hypotension, defined as a sustained decrease in systolic blood pressure (SBP) of ≥ 20 mmHg or a decrease in diastolic blood pressure (DBP) of ≥ 10 mmHg within 3 min of standing. In children, a sustained HR increment of at least 40 bpm is required for diagnosis of POTS. POTS is a common condition in adults and children suffering from myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). In daily clinical practice, therapeutic recommendations are rare and evidence is missing. The objective of this review is to present the current knowledge on non-pharmacological and pharmacological approaches in POTS with a special focus on POTS therapy in children and people with ME/CFS. Of 3853 studies, 45 studies were included in the systematic review. Evidence on therapy in POTS is rare and large randomized controlled trials (RCT) on single interventions are needed. Non-pharmacological approaches such as the use of compression garments, physical training, salt supplementation and transdermal vagal nerve stimulation could be possible treatment options in POTS because they are easy to implement as first-line therapeutic measures in clinical practice. For pharmaceuticals, several studies showed significant effects following therapy with ivabradine and β-adrenergic blocking agents. There are single studies which imply that midodrine (hydrochloride) and pyridostigmine seem to have a beneficial effect on hemodynamics in POTS.

Abstract licence: CC BY

Orthostatic hypotension (OH), defined as a sustained drop in systolic (≥20 mmHg) or diastolic (≥10 mmHg) blood pressure upon standing, is a debilitating condition prevalent in older adults and individuals with neurodegenerative disorders. It significantly impacts quality of life, leading to dizziness, falls, and syncope, and is associated with increased morbidity and mortality. This systematic review evaluates the efficacy and safety of pharmacological treatments for OH. Following the PRISMA 2020 guidelines, 25 studies, including randomized (RCTs) and non-randomized controlled trials (NRCTs), were analyzed. Study quality was assessed using the Cochrane Risk of Bias 2 (ROB 2) tool, the Joanna Briggs Institute (JBI) Checklist, and the Newcastle-Ottawa Scale (NOS). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework was applied to evaluate the certainty of evidence across key outcomes. Drugs approved by the U.S. Food and Drug Administration (FDA), such as droxidopa and midodrine, consistently improve orthostatic symptoms and are recommended as first-line therapies. Atomoxetine and fludrocortisone showed moderate efficacy, while pyridostigmine in combination therapies provided additional benefits. Octreotide demonstrated potential for refractory OH but lacked robust evidence. Adverse effects, including supine hypertension, dizziness, gastrointestinal disturbances, and fatigue, highlight the need for personalized therapy to balance efficacy and tolerability. While pharmacological treatments show promise, further comparative and long-term studies are necessary to refine therapeutic strategies and improve patient outcomes.

Abstract licence: CC BY