Top 20 Dysautonomia Pharmacological Treatments

Several drug treatments are used for autonomic nervous system disorders. Some of them are powerful or can produce harmful side effects. Patients should take medications only under the supervision of a provider with expertise and experience in the treatment of dysautonomia.

Top 20 Dysautonomia Drugs

Drug Name/Class Helps with Notes
Fludrocortisone (Florinef®)
Increase blood volume and blood pressure. May help in reducing plasma NE with long-term use. (Orthostatic intolerance and orthostatic hypotension.)
Increase dietary sodium for maximum effectiveness. Ideal in low doses.
Midodrine (Proamatine®)
Tightens blood vessels, increases blood pressure and prevents fainting. (Orthostatic hypotension, POTS and other forms of dysautonomia.)
Can cause supine hypertension.
Decrease heart rate, blood pressure and adrenaline effects. Prevents fainting. (POTS and hyperadrenergic hypertension.)
Known to cause mast cell degranulation.
Pyridostigmine (Mestinon®)
ncreases blood pressure and muscle strength. Reduces breakdown of Acetylcholine in ANS. (Chronic orthostatic hypotension.)
IV Saline
Increases in blood volume, orthostatic tolerance and cognitive function. (POTS and orthostatic hypotension)
Symptom improvement is temporary. Caution should be used when prescribing.
Clonidine (Catapres®) or Methyldopa (Aldomet®)
Decreases blood pressure and hyperadrenergic responses. Also improves sleep. Decreases sympathetic adrenergic stimulation.
Ibuprofen (Motrin®)
Tighten blood vessels. Blocks inflammatory prostaglandins.
Amphetamine (Adderall®) Or Methylphenidate (Ritalin®, Concerta®)
Tighten blood vessels. Increases alertness. Cognitive function, and improves brain fog. Reduces appetite. (Chronic orthostatic intolerance)
Use with caution as can be addictive.
Clonazepam (Klonopin®)
Regulate oscillations of blood flow to heart and vital organs and increased sense of calmness. (Multiple system atrophy and chronic orthostatic intolerance.)
Recommended start with low dose at bedtime.
Alprazolam (Xanax®)
Increase sense of calmness.
Sedative effect.
Droxidopa (Northera®) Also known as L-DOPS
Increase blood pressure. (Neurogenic orthostatic hypotension and other forms of autonomic failure)
One of the few FDA approved drugs for neurogenic. Orthostatic Hypotension.
Tricyclic Antidepressants (E.g. Doxepin)
Improves mood.
Selective Serotonin Reuptake Inhibitor, (SSRIs)
Improves mood, reduces anxiety.
May cause depression – use caution with teens.
Erythropoietin (Procrit®)
Increase blood count and blood pressure. Especially helpful with anemic patients or patients with chronic fatigue.
Difficult to gain coverage through insurance.
Increase blood pressure (Chronic autonomic failure, multiple system atrophy and automatically mediated syncope.)
Ivabradine (Corlanor®)
Reduces heart rate, angina pectoris, and improves inappropriate sinus tachycardia (IST).
Useful for patients unable to tolerate beta-blockers
Somatostatin (Octreotide®)
Tighten blood vessels in gut
Desmopressin (DDAVP®)
Tighten blood vessels and causes kidneys to retain water
Bethanechol (=Urecholine®)
Increase salivation, gut action, and urination.
H1 & H2 Antihistamines
Tightens blood vessels. Improves inflammation of the gut.
May be helpful in patients with coexisting mast cell activation.

Related Articles: 

Non-pharmacological Treatments 


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