Skip to main content Accessibility help
×
Home
Hostname: page-component-7ccbd9845f-wr4x4 Total loading time: 0.531 Render date: 2023-02-01T10:47:46.285Z Has data issue: true Feature Flags: { "useRatesEcommerce": false } hasContentIssue true

Utilisation of medications to reduce symptoms in children with postural orthostatic tachycardia syndrome

Published online by Cambridge University Press:  06 August 2018

Jeffrey R. Boris*
Affiliation:
Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
Thomas Bernadzikowski
Affiliation:
Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
*
Author for correspondence: J. R. Boris, MD, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Division of Cardiology, Philadelphia, PA 19104, USA. Tel: 215 590 3180; Fax: 267 426 5324; E-mail: borisj@email.chop.edu

Abstract

Background

Postural orthostatic tachycardia syndrome encompasses multiple disabling symptoms that interfere with daily activities. Non-pharmacologic approaches can be insufficient and can require adjunctive medications to manage symptoms. Minimal data exist in the literature on medication outcomes in these patients. We reviewed our database for medication management outcomes.

Materials and Methods

Patients aged 18 years and younger at initial diagnosis met the inclusion criteria. All prescribed patient medications were extracted from the electronic health record, excluding medications for unrelated symptoms or comorbid diseases. Medications were grouped by symptom class consistent with our programme utilisation protocol. Within symptom classification, therapy was deemed successful when a specific dose was prescribed at least five consecutive times without changes; this was confirmed by chart review. Individual medications and overall percentage of successful therapies within symptom classifications were assessed, with further analysis by gender. t-Test, χ2, and Mann–Whitney U-test were used to assess for differences in specific variables, as appropriate.

Results

A total of 708 patients met the study criteria. The percentage of patients with effective therapy by symptom includes light-headedness (52.2%), headache (48.2%), nausea (39.1%), dysmotility (43.4%), pain (53.4%), and insomnia (42.8%). Insomnia therapy was better for females; all other therapies showed no gender difference. The median number of therapies prescribed per patient per symptom was 2 for light-headedness, headache, and insomnia, and 1 for nausea, dysmotility, and pain.

Discussion

Symptoms associated with this disorder can be effectively managed with various medications. Further randomised studies are needed to better ascertain true efficacy compared with placebo.

Type
Original Article
Copyright
© Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Arnold, AC, Ng, J, Raj, SR. Postural tachycardia syndrome – diagnosis, physiology, and prognosis. Auton Neurosci 2018; https://doi.org/10.1016/j.autneu.2018.02.005.CrossRefGoogle ScholarPubMed
2. Sandroni, P, Opfer-Gehrking, TL, McPhee, BR, Low, PA. Postural tachycardia syndrome: clinical features and follow-up study. Mayo Clin Proc 1999; 74: 11061110.CrossRefGoogle ScholarPubMed
3. Stewart, JM, Boris, JR, Chelimsky, G, et al. Pediatric disorders of orthostatic intolerance. Paediatrics 2018; 141 https://doi.org/10.1542/peds.2017-1673.CrossRefGoogle ScholarPubMed
4. George, SA, Bivens, TB, Howden, EJ, Saleem, Y, Hendrickson, D, Fu, Q, Levine, BD. The international POTS registry: evaluating the efficacy of an exercise training intervention in a community setting. Heart Rhythm 2016; 13: 943950.CrossRefGoogle Scholar
5. Kanjwal, K, Saeed, B, Karabin, B, Kanjwal, Y, Grubb, BP. Use of methylphenidate in the treatment of patients suffering from refractory postural tachycardia syndrome. Am J Ther 2012; 19: 26.CrossRefGoogle ScholarPubMed
6. Raj, SR, Black, BK, Biaggioni, I, Paranjape, SY, Ramirez, M, Dupont, WD, Robertson, D. Propranolol decreases tachycardia and improves symptoms in the postural tachycardia syndrome: less is more. Circulation 2009; 120: 725734.CrossRefGoogle ScholarPubMed
7. Grubb, BP. Postural tachycardia syndrome. Circulation 2008; 117: 28142817.CrossRefGoogle ScholarPubMed
8. Boris, JR. The role of the cardiologist in the evaluation of dysautonomia. Cardiol Young 2010; 20 (Suppl 3): 135139.CrossRefGoogle ScholarPubMed
9. Harris, PA, Taylor, R, Thielke, R, Payne, J, Gonzalez, N, Conde, JG. Research electronic data capture (REDCap) – a metadata-drive methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42: 377381.CrossRefGoogle ScholarPubMed
10. Freitas, J, Santos, R, Azevedo, E, Costa, O, Carvalho, M, de Freitas, AF. Clinical improvement in patients with orthostatic intolerance after treatment with bisoprolol and fludrocortisone. Clin Auton Res 2000; 10: 293299.CrossRefGoogle ScholarPubMed
11. Hoeldtke, RD, Horvath, GG, Bryner, KD, Hobbs, GR. Treatment of orthostatic hypotension with midodrine and octreotide. J Clin Endocrinol Metab 1998; 83: 339343.Google ScholarPubMed
12. Lai, CC, Fischer, PR, Brands, CK, Fisher, JL, Porter, CB, Driscoll, SW, Graner, KK. Outcomes in adolescents with postural orthostatic tachycardia syndrome treated with midodrine and beta-blockers. Pacing Clin Electrophysiol 2009; 32: 234238.CrossRefGoogle ScholarPubMed
13. Chen, L, Wang, L, Sun, J, Qin, J, Tang, C, Jin, H, Du, J. Midodrine hydrochloride is effective in the treatment of children with postural orthostatic tachycardia syndrome. Circ J 2011; 75: 927931.CrossRefGoogle ScholarPubMed
14. Coffin, ST, Black, BK, Biaggioni, I, Paranjape, SY, Orozco, C, Black, PW, Dupont, WD, Roberson, D, Raj, SR. Desmopressin acutely decreases tachycardia and improves symptoms in the postural tachycardia syndrome. Heart Rhythm 2012; 9: 14841490.CrossRefGoogle ScholarPubMed
15. Gachoka, D, Kanjwal, K, Karabin, B, Grubb, BP. Desmopressin in the treatment of postural orthostatic tachycardia. J Innov Card Rhythm Management 2015; 6: 22222226.Google Scholar
16. Hoeldtke, RD, Davis, KM, Joseph, J, Gonzales, R, Panidis, IP, Friedman, AC. Hemodynamic effects of octreotide in patients with autonomic neuropathy. Circulation 1991; 84: 168176.CrossRefGoogle ScholarPubMed
17. Kanjwal, K, Saeed, B, Karabin, B, Kanjwal, Y, Grubb, BP. Use of octreotide in the treatment of refractory orthostatic intolerance. Am J Ther 2012; 19: 710.CrossRefGoogle ScholarPubMed
18. Kanjwal, K, Saeed, B, Karabin, B, Kanjwal, Y, Sheikh, M, Grubb, BP. Erythropoietin in the treatment of postural orthostatic tachycardia syndrome. Am J Ther 2012; 19: 9295.CrossRefGoogle ScholarPubMed
19. Mar, PL, Raj, V, Black, BK, Biaggioni, I, Shibao, CA, Paranjape, SY, Dupont, WD, Robertson, D, Raj, SR. Acute hemodynamic effects of a selective serotonin reuptake inhibitor in postural tachycardia syndrome: a randomized, crossover trial. J Psychopharmacol 2014; 28: 155161.CrossRefGoogle ScholarPubMed
20. Gaffney, FA, Lane, LB, Pettinger, W, Blomqvist, CG. Effects of long-term clonidine administration on the hemodynamic and neuroendocrine postural responses of patients with dysautonomia. Chest 1983; 83 (2 Suppl): 436438.CrossRefGoogle ScholarPubMed
21. Raj, SR, Black, BK, Biaggioni, I, Harris, PA, Robertson, D. Acetylcholinesterase inhibition improves tachycardia in postural tachycardia syndrome. Circulation 2005; 111: 27342740.CrossRefGoogle ScholarPubMed
22. Gales, BJ, Gales, MA. Pyridostigmine in the treatment of orthostatic intolerance. Am Pharmacother 2007; 41: 314318.CrossRefGoogle ScholarPubMed
23. Kanjwal, K, Karabain, B, Sheikh, M, Elmer, L, Kanjwal, Y, Saeed, B, Grubb, BP. Pyridostigmine in the treatment of postural orthostatic tachycardia: a single-center experience. Pacing Clin Electrophysiol 2011; 34: 750755.CrossRefGoogle ScholarPubMed
24. Powers, SW, Coffey, CS, Chamberlin, LA, Ecklund, DJ, Klingner, EA, Yankey, JW, Korbee, LL, Porter, LL, Hershey, AD, CHAMP Investigators. Trial of amitriptyline, topiramate, and placebo for pediatric migraine. New Engl J Med 2017; 376: 115124.CrossRefGoogle ScholarPubMed
25. Finniss, DG, Kaptchuk, TJ, Miller, F, Benedetti, F. Biological, clinical, and ethical advances of placebo effects. Lancet 2010; 375: 686695.CrossRefGoogle ScholarPubMed
26. Oigaard, A. The motor-stimulating effect of metoclopramide and pyridostigmine bromide in normal man and laparotomized patients. A combined study of duodenal Electric and motor activity. Scand J Gastroenterol 1975; 10: 6571.Google ScholarPubMed
27. Manini, ML, Camilleri, M, Grothe, R, Di Lorenzo, C. Application of pyridostigmine in pediatric gastrointestinal motility disorders: a case series. Paediatr Drugs 2017; 20: 173180.CrossRefGoogle Scholar
28. Coffin, ST, Black, BK, Biaggioni, I, Paranjape, SY, Orozco, C, Black, PW, Dupont, WD, Robertson, D, Raj, SR. Desmopressin acutely decreases tachycardia and improves symptoms in the postural tachycardia syndrome. Heart Rhythm 2012; 9: 14841490.CrossRefGoogle ScholarPubMed
8
Cited by

Save article to Kindle

To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Utilisation of medications to reduce symptoms in children with postural orthostatic tachycardia syndrome
Available formats
×

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

Utilisation of medications to reduce symptoms in children with postural orthostatic tachycardia syndrome
Available formats
×

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

Utilisation of medications to reduce symptoms in children with postural orthostatic tachycardia syndrome
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *