Desmopressin acutely decreases tachycardia and improves symptoms in the postural tachycardia syndrome

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 <.001). Standing blood pressure was not affected (P = .28). The symptom burden improved with DDAVP (from a score of 18 +/- 18 arbitrary units [AU] to 13 +/- 15 AU at 2 hours) compared with placebo (from 18 +/- 17 AU to 19 +/- 16 AU; P = .010). 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.