Meds To Bump Pressure

[cardiactec]

Hi all,

I have tried florinef, clonidine, and midodrine in the past, in all different combo's and none of them helped with my light-headedness issues.

I saw my PCP yesterday and my BP in his office was 76/40 and I felt so light-headed and dizzy it wasnt even funny. I am on a lot of beta's which may be contributing to the low BP, but the doc's dont really want to pull me from my BB's because of my crazy HR (even on beta, my rates can still get up to 180's).

Any thoughts of other meds, specifically any NEW meds, that would help kick up my pressure? I have been salt loading and increasing my water as much as possible, though it is difficult because of my gastroparesis/nausea/vomiting issues.

Thanks for any suggestions!

[dsdmom]

Just brainstorming here...but would you consider something like Effexor? Or something else that may even at a low dose cause the side effect of increased bp?

May not be a good choice for you but just thought I'd throw it out there...

[yogini]

Have you tried mestinon?

[cardiactec]

hi, i haven't tried effexor. i am curious if it might have too many GI side effects for me to handle. with my gi issues, gastroparesis, a lot of the SSRI's have major GI side effects such as nausea and loss of appetite....

mestinon, i am pretty sure i tried awhile back and like the above mentioned, i think it caused a lot of GI disturbance.

thanks for the suggestions though. any other thoughts, keep them flowing!

[cardiactec]

has anyone heard about ritalin being used for hypotension? probably wouldnt be good though in pots patients as i think one of the side effects is pounding heart! lol, got that covered already!

[EarthMother]

What helped me the most in my younger years was the really really high compression stocking. I would get the Jobst thigh highs, because I didn't want to have additional pressure on my stomach. But the thigh highs did the trick and allowed me to work for many more years than I would have been able to otherwise.

Good luck finding something that works for you.

~EM

[Ernie]

Hi,

Cymbalta

[pat57]

I second the compression stockings.

[ramakentesh]

Your post reminds me of how i felt this morning.

For me the lightheadedness can be quickly reduced to comfortable levels with a dose of licorice.

I use it as an immediate blood pressure booster as well as its long term effect of increasing blood volume.

But i find that if I take too much of the tea form i get a migraine so if you suffer from these be careful.

Ive actually found the best stuff - better than the extract recommended by my POTS specialist - is actually a local made variety of the candy form - probably not so healthy considering the large amont of sugar, but today i had one long strand and I went from total lightheadedness to standing upright in a park this afternoon examining plants and talking to friends without anyone noticing I felt at all unwell.

For me POTS without licorice would be a nightmare.

[EarthMother]

Licorice! I never tried it, but wondered why when I was in the hospital last June one of the intending specialists kept asking (more like insinuating) if I was taking licorice! I said no (a few times). Then on my chart she writes "Patient denys taking licorice."!

I'll have to keep this one in mind if my bp starts falling again. Right now with salt loading it's stable ... but the tachycardia on standing is still outrageous.

[cardiactec]

never heard of licorice either. will give it a shot. thanks for the advice!

i dont think i'd do well with cymbalta or any SSRI, SSNI as the majority of them have major GI side effects and my tum can't take any more nausea/vomiting.

[flop]

Liquorice contains a chemical very similar to fludrocortisone that makes you retain water and sodium from the urine. You shouldn't take liqorice and florinef together but several people use liqorice as an alternative to florinef. It has to be the glycyrrhinated(?spelling) form.

Quote from Wikipedia -

Large doses of glycyrrhizinic acid and glycyrrhetinic acid in liquorice extract can lead to hypokalemia and serious increases in blood pressure, a syndrome known as apparent mineralocorticoid excess.

Hope you find something that you can tolerate!

Flop

[ramakentesh]

It also gives you a sudden BP boost when you take it at the time you take it - it works for me most of the time - although its dosage dependent on how bad im feeling from lack of blood to the brain from POTS.

The tachy doesnt worry any more - you know the only symptom i really hate is when you cant think straight/lightheaded/out of it from lack of blood to the brain... That and feeling like your gonna pass out at any moment when walking in a busy place...

[dsdmom]

Do a search on licorice on this forum to read about the different forms...

I totally forgot about it and I took it for months! I think it did help a little for me but it also aggravated my reflux so I had a lot of chest pain from it (not a normal response). Good luck!

[Sunfish]

re: your question about ritalin, i haven't used ritalin specifically but have taken several meds in the same family & have in fact had a decent amount of success. since i know you're a science person you may be intrigued to know that midodrine/ proamatine was actually developed as a result of the success seen with the use of ritalin in studies of those with orthostatic hypotension. i'm a bit foggy/ crashed at the moment so my explanation is likely to be lacking but i'll try for a short version at least. as you likely know ritalin & its family of drugs cross the blood brain barrier & thus have more of an effect - intended &/or unintended - on the central nervous system. a common side effect however is vasoconstriction - causing unwanted high BP for some taking it for ADD/ ADHD - &, as such, there have been research studies (quite some time ago) indicating some effectiveness with the use of ritalin in those with orthostatic hypotension. due to CNS effects that were a bother to some &/or to the regulatory issues, i.e. the fact that ritalin et al are more regulated due to the class of drugs they fall in, someone decided to try for a med that had the vasoconstrictive benefits without the CNS effects. and then there was midodrine. bear with my poor explanation but essentially the ritalin family of meds all have an alpha & a beta component to their make up. i'm not sure if it matters which is which for the scientific merit, but for the sake of conversation let's say that the alpha component is the part that causes the CNS issues & the beta is related to the vasoconstriction. i'm sure you get where i'm going. they were able to isolate the beta component so that the advantanges of the vasoconstriction could be had without the effects & the regulatory issues of the alpha component. hopefully you get the idea .

that said, some individuals needing the vasoconstrictive component also end up benefiting from the CNS component....not generally in the way that one with ADD/ ADHD might but rather in the other direction. rather than the paradoxical effect of the stimulant seen in those with ADD/ ADHD some with orthostatic issues/ dysautonomia have cognitive &/or fatigue issues such that they benefit from the CNS effects of a stimulant. thus they do better on something in the ritalin family than on "just" midodrine. though of course, as is the case with just about everything, this is definitely not the case for everyone. and it's definitely true that some people with more "hyper" type issues to their dysautonomia have more trouble than benefit from taking a stimulant. for some a high heart rate is still helped b/c the vasoconstriction helps to raise BP which in turn reduces the need for compensatory tachycardia, but of course nothing works for every individual situation. and i know that you're someone who deals with particularly high heart rates. i know for some they also cause problems with anxiety issues, physically &/or mentally, though i would guess this is more likely in those who are predisposed to such issues, something i'm thankful to never have dealt with as part of my health mix.

as for my personal experience, concerta was a key part of my regimen at one point several years back, as is daytrana now. though in all honestly the daytrana (a patch) seems to have more of an effect on my cognitive abilities than on my BP. the concerta definitely helped keep my BP up. i also tried adderall at one point but had side effects that were a deal breaker such that i can't say whether or not there was a benefit otherwise. in various combinations i have also taken midodrine at the same time as these meds as well. and for what it's worth i've never had an issue with a prevalence of hyper-type symptoms, for lack of a better way to describe it. while i did have the POTS diagnosis at one point with heart rates that went into the low/ mid 200s orthostatically, they were always very clearly compensatory for me & i've never dealt with any other part of my body being in overdrive in any way but rather the exact opposite. other that the fact that i talk fast the rest of me needs speeding up & has for years, which may very well correspond with the fact i've done fairly well with the stimulant meds.

re: some of the things others have mentioned, just an fyi that some folks with nausea/ dysmotility issues actually find some relief from SSRIs, i'm not one of them but just thought i'd mention that they're not always a bad mix with GI issues. i think nina may be one whose GI issues benefit from a small dose of SSRI.

i'm also a big fan of compression hose but be aware that you might not be able to tolerate waist-high hose due to GI issues, pacer placement, etc. i don't have a pacer but b/c of my J tube can't wear waist high hose any more. even though they are the ideal style for orthostatic support thigh highs are better than nothing & of course don't interfere with anything GI wise. b/c actually even without my G/ J tubes the waist high hose often aggravated my GI issues pretty significantly.

hope this helps,

melissa

[cardiactec]

hey melissa, thanks so much for sharing that info with me. i appreciate it. god know i'd give ritalin a shot if i didnt think it would cause severe tachy issues on top of my already ready severe high heart rates. as for SSRI's, i have tried a couple low dose SSRI's and they caused GI issues along with some other bizarre side effects......

my cardiologist has called in florinef, so i guess i'm going to try that again, for like the fourth time. lol.

[ajw4790]

Hi,

How about Procrit (Epogen), DDAVP, Ivabradine, or Octreocide? I think they can all boost BP. Or any of the vasoconstrictors, such as ergotamine, ephedrine, pseudoephedrine, yohimbine, theophylline or ritalin? I know many also can increase HR as well, so may not be a good fit. Also, with the GI issues I am not sure what is best to use?

Just thought I would add a couple thoughts I had.