Desmopressin acutely decreases tachycardia and improves symptoms in the postural tachycardia syndrome
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Background Postural tachycardia syndrome (POTS) induces disabling chronic orthostatic intolerance with an excessive increase in heart rate on standing, and many patients with POTS have low blood volume. Increasing blood volume is a promising approach to this problem. Objective To test the hypothesis that desmopressin (DDAVP) will attenuate the tachycardia and improve symptom burden in patients with POTS. Methods In this protocol, patients with POTS (n = 30) underwent acute drug trials with DDAVP 0.2 mg orally and placebo, on separate mornings, in a randomized crossover design. Blood pressure, heart rate, and symptoms were assessed while seated and after standing for up to 10 minutes prior to and hourly for 4 hours following study drug. Results The standing heart rate was significantly lower following DDAVP than placebo (101.9 ± 14.5 beats/min vs 109.2 ± 17.4 beats/min; P Conclusions Oral DDAVP significantly attenuated tachycardia and improved symptoms in POTS. The safety profile of this approach would need to be examined before it can be recommended for routine treatment of these patients.
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Desmopressin acutely reduces orthostatic tachycardia in patients with POTS.
“It has been shown to acutely reduce orthostatic tachycardia in patients with POTS,53”
From Diagnosis and management of postural orthostatic tachycardia syndrome (2022) · cites this paper as [53]
Three experimental proof-of-concept trials of Desmopressin, Pyridostigmine, and Propranolol (low dose more than high dose and high dose more than placebo) were effective in reducing symptom burden compared to placebo or high dose controls after 4 h tilt test.
“Three of these experimental proof-of-concept trials, of Desmopressin, Pyridostigmine, and Propranolol (low dose more than high dose and high dose more than placebo) were effective in reducing symptom burden compared to placebo or high dose controls after 4 h tilt test.”
From Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies (2023) · cites this paper as Coffin et al., 2012
DDAVP reduces tachycardia and symptoms in POTS.
“Although DDAVP reduces tachycardia and symptoms [72;71], it can lead to hyponatremia.”
From Postural tachycardia syndrome: beyond orthostatic intolerance (2015) · cites this paper as [72]
DDAVP can lead to hyponatremia.
“Although DDAVP reduces tachycardia and symptoms [72;71], it can lead to hyponatremia.”
From Postural tachycardia syndrome: beyond orthostatic intolerance (2015) · cites this paper as [72]
Short-term administration of oral DDAVP and water to POTS patients resulted in standing heart rates significantly lower than after placebo administration.
“The short-term administration of oral DDAVP and water to POTS patients resulted in standing heart rates significantly lower than that after placebo administration (69).”
From Postural orthostatic tachycardia syndrome: mechanisms and new therapies (2020) · cites this paper as [69]
POTS patients taking DDAVP noted significant improvements in overall symptoms, specifically symptoms related to vision, tremulousness, and palpitations.
“Patients also noted significant improvements in overall symptoms, specifically symptoms related to vision, tremulousness, and palpitations (69).”
From Postural orthostatic tachycardia syndrome: mechanisms and new therapies (2020) · cites this paper as [69]
Acute restoration of blood volume with intravenous saline or the vasopressin analog desmopressin attenuates standing heart rate and improves symptom burden in POTS.
“acute restoration of blood volume with either intravenous saline or the vasopressin analog desmopressin attenuates standing HR and improve symptom burden in these patients”
From Postural tachycardia syndrome – Diagnosis, physiology, and prognosis (2018) · cites this paper as Coffin et al., 2012
Evidence for desmopressin in POTS is sparse and its efficacy is uncertain.
“Sparse evidence exists. Efficacy uncertain [102]”
From Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management (2019) · cites this paper as [102]
The Vanderbilt Orthostatic Symptoms Scale (VOSS) was used to measure standing symptom burden.
“Patients were asked to report their standing symptom burden at the end of the Stand portion of the posture study, using the Vanderbilt Orthostatic Symptoms Scale (VOSS) (16).”
From Effect of High Dietary Sodium Intake in Patients With Postural Tachycardia Syndrome (2021) · cites this paper as [16]
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Current look on postural tachycardia syndrome
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Diagnostic et traitement du syndrome de tachycardie orthostatique posturale
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Self-citationNovel pharmacotherapeutic options for the treatment of postural orthostatic tachycardia syndrome
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Management of Postural Orthostatic Tachycardia Syndrome: A Canadian Approach
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Differential Diagnosis of Vasovagal Syncope: Postural Orthostatic Tachycardia
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Self-citationOther Medications: Desmopressin, Pyridostigmine, Erythropoietin and SSRIs
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Desmopressin in the postural tachycardia syndrome
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LC, POTS, and ME/CFS: Lifting the FogPreprint
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Long Covid, POTS, and ME/CFS: Lifting the FogPreprint
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Long COVID, POTS, CFS and MTHFR: Linked by Biochemistry and NutritionPreprint
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Confounders of Vasovagal Syncope Tachycardia Syndrome
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Self-citationOBSOLETE: Sinus Tachycardias: Inappropriate Sinus Tachycardia and Postural Tachycardia Syndrome
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Self-citationDETERMINATION OF A PLASMA EMITTER FORM IN AN ACCELERATING ELECTRIC FIELD.
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Sinus Tachycardias: Inappropriate Sinus Tachycardia and Postural Tachycardia Syndrome
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Self-citationLC, POTS, and ME/CFS: Lifting the FogPreprint
Chambers, P. W. (2023) · doi:10.32388/nlr1k8
LC, POTS, and ME/CFS: Lifting the FogPreprint
Chambers, P. W. (2023) · doi:10.32388/nlr1k8.2
Sinus Tachycardias: Inappropriate Sinus Tachycardia and Postural Orthostatic Tachycardia Syndrome
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Postural Orthostatic Tachycardia Syndrome (POTS)
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Self-citation
- Authors
- Coffin, S. T., Black, B. K., Biaggioni, I., Paranjape, S. Y., Orozco, C., Black, P. W., Dupont, W. D., Robertson, D., & Raj, S. R.
- Affiliations
- Vanderbilt University (US)
- Corresponding author
- Raj, Satish R.
- Venue
- Heart Rhythm
- Publisher
- Elsevier BV
- Published
- 2012-09
- Volume
- 9
- Issue
- 9
- Pages
- 1484-1490
- ISSN
- 1547-5271 (ISSN-L)
- PMC
- PMC3419341
- OpenAlex
- W2090908693
- Cited by
- 88
- References
- 19
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 10 · 2023: 9 · 2022: 8 · 2021: 5 · 2020: 6 · 2019: 3 · 2018: 6 · 2017: 6 · 2016: 6 · 2015: 4 · 2014: 9 · 2013: 4 · 2012: 3
- FWCI
- 6.53
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Heart Rhythm (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Vanderbilt University
- National Heart, Lung, and Blood Institute (R01HL071784, P01HL056693, R01HL102387, P01 HL-56693)
- National Institute of Neurological Disorders and Stroke (R01NS055670)
- National Center for Research Resources (KL2RR024977, TL1RR024978, UL1RR024975, K23RR020783)
- 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 › Neurology › Long-Term Effects of COVID-19
- Keywords
- postural orthostatic tachycardia syndrome, desmopressin, orthostatic intolerance, heart rate, blood volume, symptom burden, vasopressin analogue
- MeSH terms
- Adult, Analysis of Variance, Autonomic Nervous System, Blood Pressure, Deamino Arginine Vasopressin, Female, Health Status Indicators, Heart Rate, Hemostatics, Humans, Male, Pilot Projects, Single-Blind Method, Antidiuretic Agents, Postural Orthostatic Tachycardia Syndrome
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