Ritalin And Pots

[firewatcher]

Use of Methylphenidate in the Treatment of Patients Suffering From Refractory Postural Tachycardia Syndrome.

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

Am J Ther. 2010 May 10. [Epub ahead of print]

1Section of Electrophysiology, Division of Cardiology, Department of Medicine; and 2Division of Internal Medicine, Department of Medicine, University of Toledo Medical Center, Toledo, OH.

Abstract

Methylphenidate (Ritalin) 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

[wareagle]

Thanks for the post. I'm considering trying Ritalin soon...maybe it will help!

[sue1234]

Sounds interesting! Can someone explain if it seems to be for most people with POTS, regardless of high or low b/p associated with the tachycardia when standing?? I get the higher b/p when standing, so wondering if it would make that worse, or not have any negative effect of it at all.

Also, what is the physiological action of Ritalin? Just curious how it helps.

[summer]

Thank you for posting this, Firewatcher. I have also been thinking about this for a while because of my brain fog issues. It would be amazing if it could help my brain fog as well as my other symptoms!

One thing I wonder about, that makes me a little reluctant to try it, is that it seems to work because of the vasoconstrictive effect which raises BP. How would that effect low flow POTS, seeing as there is already to much constriction? Would it be appropriate for me if this is the kind of POTS I have?

Anyone have any thoughts about this?

[summer]

Sorry, Sue- Looks like our questions may be similar. I guess I was typing when you posted .

[TXPOTS]

Same question here about low flow POTS and vasoconstriction. These studies are not breaking patients up into subgroups. I would guess Ritalin is best for patients that are vasodilated and may make patients with vasoconstriction worse.

[firewatcher]

We should know more about the study participants once the article actually comes out. It is ahead of print. By looking at the baseline characteristics, we should be able to figure out which subset it helps.

Or if anyone is seeing Dr. Grubb soon, they could ask him, since he did the study.