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Cited by 57Cardiovascular Syncope and Autonomic DisordersHeart Rate Variability and Autonomic ControlGastrointestinal motility and disorders

Treatment of postural tachycardia syndrome: a comparison of octreotide and midodrine

Hoeldtke, Robert D., Bryner, Kimberly D., Hoeldtke, Martin E., Hobbs, Gerald·2006·Clinical Autonomic Research
DOI 10.1007/s10286-006-0373-0
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Abstract

We assessed the potency of octreotide and midodrine, and their combination, in the treatment of the postural tachycardia syndrome (POTS) and orthostatic intolerance (OI). Nine patients with POTS and six patients with OI stood for up to 1 hour while their HR and BP were monitored. Patients received on separate days, midodrine 10 mg 1 hour before testing, octreotide 0.9 micro g/kg 8 minutes before testing or combination therapy. Standing time in the patients with POTS was 41.2 +/- 8.4 minutes and not improved by midodrine or octreotide, but increased to 56.3 +/- 2.7 (P < 0.01) minutes following combination therapy. The standing heart rate in POTS, 114 +/- 0.7 bpm, was suppressed by midodrine 92.8 +/- 0.7 (P < 0.001), octreotide 90.6 +/- 0.78 (P < 0.001), and combination therapy 84.7 +/- 0.7 (P < 0.001). Combination therapy was better than monotherapy (P < 0.001) but only for the first 10 minutes of standing. Standing time of 36.3 +/- 3.5 minutes in the patients with OI improved with midodrine, octreotide and combination therapy (55.5 +/- 3.1, 56.5 +/- 3.5, and 56.6 +/- 3.3, respectively, P < 0.05 for each). Standing heart rate in OI was 100 +/- .76 bpm; following midodrine it was 80.3 +/- .69 (P < 0.05), following octreotide it was 84.8 +/- .86, and following combination therapy it was 71.2 +/- .9 (P < 0.01). The RR interval versus time area under the curve (The Orthostatic Index) was 21.1 +/- 4 in patients with OI. After midodrine it was 41.4 +/- 3.5 (P < 0.01), after octreotide 40.3 +/- 3.8 (P < 0.01) and after the combination it was 47.3 +/- 4.6 (P < 0.001). Midodrine and octreotide suppressed tachycardia in POTS and improved standing times in OI. The two drugs had similar potencies; combination therapy was not significantly better than monotherapy.

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  • Octreotide helps maintain venous return during standing in POTS and inhibits the compensatory heart rate increase after acute and chronic administration.

    “This effect during standing helps to maintain venous return in POTS and inhibits the compensatory increase in HR following acute and chronic administration [68;69].”

    From Postural tachycardia syndrome: beyond orthostatic intolerance (2015) · cites this paper as [68]

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Authors
Hoeldtke, R. D., Bryner, K. D., Hoeldtke, M. E., & Hobbs, G.
Affiliations
West Virginia University (US)
Corresponding author
Hoeldtke, Robert D.
ORCID
Hobbs, Gerald
Venue
Clinical Autonomic Research
Publisher
Springer Science and Business Media LLC
Published
2006-10-11
Volume
16
Issue
6
Pages
390-395
ISSN
  • 0959-9851 (ISSN-L)
  • 1619-1560
DOI
10.1007/s10286-006-0373-0
OpenAlex
W2078386231
Cited by
57
References
16
Citations by year
2026: 3 · 2025: 2 · 2024: 1 · 2023: 2 · 2021: 5 · 2020: 4 · 2019: 3 · 2018: 6 · 2016: 1 · 2015: 3 · 2014: 6 · 2013: 5 · 2012: 2
FWCI
2.71
Type
journal article
Language
en
Open access
closed
Licence
www.springer.com/tdm (tdm)
Locations
  • Clinical Autonomic Research (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
Keywords
postural orthostatic tachycardia syndrome, orthostatic intolerance, octreotide, midodrine, combination therapy, heart rate, standing time, vasopressor therapy, autonomic dysfunction, drug efficacy comparison, heart rate variability, blood pressure response to standing, adverse effects, cost-effectiveness, patient satisfaction, quality of life
MeSH terms
Adult, Blood Pressure, Data Interpretation, Statistical, Dizziness, Drug Therapy, Combination, Female, Heart Rate, Humans, Middle Aged, Midodrine, Posture, Syndrome, Tachycardia, Time Factors, Vasoconstrictor Agents, Octreotide, Treatment Outcome

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