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. |
|
Beta-Blocker |
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. |
|
Yohimbine |
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. |