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Use of methylphenidate in the treatment of patients suffering from refractory POTS

Discussion in 'Problems Standing: Orthostatic Intolerance; POTS' started by nanonug, Nov 21, 2012.

  1. nanonug

    nanonug Senior Member

    Virginia, USA
    1. Am J Ther. 2012 Jan;19(1):2-6.

    Use of methylphenidate in the treatment of patients suffering from refractory
    postural tachycardia syndrome.

    Kanjwal K, Saeed B, Karabin B, Kanjwal Y, Grubb BP.

    Section of Electrophysiology, Division of Cardiology, Department of Medicine,
    University of Toledo Medical Center, Toledo, OH 43614, USA.

    Methylphenidate has been shown to be an effective therapy in patients with
    refractory neurocardiogenic syncope. However, the role of methylphenidate in
    patients suffering from postural orthostatic tachycardia (POTS) has not been
    reported. The study was approved by the institutional review board. A
    retrospective nonrandomized analysis was preformed on 24 patients evaluated at
    our autonomic center for POTS from 2003 to 2010. The diagnosis of POTS was based
    on patient history, physical examination, and response to head up tilt table
    testing. The mean follow-up period was 9 ± 3 months. The patients were included
    in the current study if they had a diagnosis of POTS with severe symptoms of
    orthostatic intolerance and were refractory to the commonly used medications. All
    of these patients were started on methylphenidate and the response to therapy was
    considered successful if it provided symptomatic relief. Twenty-four patients
    (age 28 ± 12, 20 women) met inclusion criterion for this study. The response to
    treatment was assed subjectively in each patient and was collected in a
    retrospective fashion from patient charts and physician communications. Four
    patients reported side effects in the form of nausea and 2 ultimately had to
    discontinue the treatment. Another 4 patients had a follow-up of less than 6
    months. Thus, only 18 patients who received methylphenidate completed the
    follow-up of 6 months. Out of these 18 patients, 14 (77%) patients reported
    marked improvement in their symptoms. Nine out of 12 patients who had recurrent
    episodes of syncope reported no syncope at 6 months of follow-up. Fourteen (77%)
    patients reported marked improvement in their symptoms of fatigue and presyncope.
    Four patients continue to have symptoms of orthostatic intolerance and 3
    continued to have recurrent episodes of syncope. Methylphenidate may be
    beneficial in patients with otherwise refractory postural tachycardia syndrome.

    PMID: 20460983

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