List Of Vasconstrictive/pressor Medications/therapies

[ramakentesh]

Something that may be of interest:

List of pressor agents with potential to be used in POTS/dysautonomia treatment:

* Midodrine - selective alpha 1 adreno-receptor agonist - no beta receptor agonism

* Dehydroergotamine - alpha 1 and serotonin receptor peripheral vasoconstrictor - more selective for venous constriction

* Ergotamine - vasoconstrictor via various mechanisms - large side effect profile

* Pseudoephedrine - weak selective alpha agonism, releases NE presynaptically that activates receptors on neural synapse

* Phenylephrine - selective alpha 1 receptor agonist (similar in action to midodrine)

* Synephrine - extract from citric fruits - mild non selective vasoconstrictor with anti-inflammatory actions

* Octreotide - selective splanchnic (stomach) vasoconstrictive peptide

* Yohimbine - alpha 2 receptor antagonist (use with caution in POTS)

* 1,3 - dimethylamylamine - non selective vasoconstrictor with baroflex mediated reductions in heart rate - caution advised as adverse effects have been reported (death).

* Ritalin/Adderal - no selective vasoconstrictors (may stimulate beta receptors).

* Antihistamines - may have mild vasoconstrictive properties.

* Butchers broom - Ruscusin saponins activate alpha 1 and perhaps alpha 2 constrictor receptors - mild glycolic acid content

* Horse Chestnut - Aescin - selective venous constrictor via serotonin or prostaglandin synthesis effects - warning POTENT

* Diosmin - extract from citrus fruits - increases actions of NE in synapse via increased calcium channel mediation

* Rutin - considered too mild to have an noticable effect.

[ramakentesh]

Caffeine should also be there but its central effects are greater than its peripheral and it is short acting.

[ramakentesh]

Non selective pressors in general have the potential to activate beta receptors - in other words potentially worsen tachycardia.

[AussieOI]

Most interesting Rama. So what's your conclusion? Which is the most powerful and best to use for POTS patients? Some of them seem to have some real negatives.

[Kellysavedbygrace]

A couple of notes re: Adderall and Antihistamines

Adderall- not sure what you mean Ram when saying "no selective vasoconstrictors." I was told by Dr. Randy Thompson that the number one reason I should try Adderall is for the strong vasoconstrictor effect. (The secondary reasons were: to stimulate circulation and improve fatigue.). I have found this med to be by far the most helpful on good days and I suspect it is the vasoconstriction that helps the most. As a side note, my circulation issues have been greatly improved since starting this med which I was very reluctant to try. Took me about a year and a half to be willing to try it as I don't like taking drugs that are known to be habit forming and I struggle at times with palipitations so I was fearful this would make my heart problems worse. I have not had an issue with either of these concerns. (I am taking 10mg 2/3x a day.). I would highly recommend trying Adderall for anyone who is looking to achieve significant vasoconstriction.

Antihistamines- these do not constrict the blood vessels but they do improve circulation by decreasing vasodilation in some patients who have histamine release which occurs near the blood vessels as in patients with MCAD. Histamine, the most well known chemical mediator released by mast cells(allergy cells), is a well known vasodilator. So the way antihistamines work is simply blocking the histamine effect thereby decreasing vasodilation. Although I have no sinus problems or acid reflux issues I'm on high dose Claritan and Pepcid. These H1 and H2 blockers have been the second most helpful med in my current treatment plan. The first week I started them it was my first experience of significant relief from brain fog. As w/ the Adderall above, they only seem to help on "good days.". All that to say antihistamines would have no effect on vasoconstriction unless there is an underlying histamine problem.

[ramakentesh]

Adderall is non selective because it doesn't agonise alpha receptors directly, rather it stimulates release of presynaptic NE which can then agonise receptors present at the synapse.

Adderall therefore can activate beta receptors and worsen tachycardia. I don't think this is a problem but it has little direct alpha agonism thus is non selective. It is a potent vasoconstrictor - but it acts on both alpha receptors.

As for antihistamines - work in the 60s-80s suggests that h1 histimine receptor agonism cause vasoconstriction of small vessels which was concluded at that time to mean that histamine may be used by small vessels along with hydrogen sulfide to vasodilate. this is contentious as h1 old school antihistamines reduce sympathetic activity centrally causing blunted vasoconstriction so I wrote 'may'. that is ignoring the obvious blunting of histamine-related vasodilation.

[ramakentesh]

What I find interesting is that some pptsies tolerate meds that also increase central dopamine quite well.

[ramakentesh]

Antihistamine and vasoconstrictive effects:

http://ajplegacy.physiology.org/content/209/3/550.abstract

[Kellysavedbygrace]

Rama, you amaze me with the breadth of your knowledge. Interesting background info about antihistamines nonetheless antihistamines primarily block vasodilation. Which meds are you referring to re: increasing central dopamine? And out of curiosity which meds are you on? If any.

[ramakentesh]

Bump in case this is of interest

[ramakentesh]

Im on florinef and either mido or pseudo on bad days. However on full crash days nothing touches it often

[Anoj]

what about wellbutrin? doesn't that act on dopamine?

I couldn't tolerate it. I can't tolerate any stimulant, either, including caffeine or Adderall. does weird things to my brain.

[Finnmin]

This is very interesting. Ever since I read about the discovery of alpha 1 adrenergic receptor autoantibodies in some POTS patients, I've been trying to read the signs if my husband is one of them. And if so, what to do about it, since his normal blood pressure is high and there for vasoconstrictors might make his bp even higher.  I know that our neurologist should be the one thinking about the right medication and not I, but if he says no to vasoconstrictors, at least we could try some herbal remedy and see if there's any change.

My husband has visible veins and if I block them with my finger, it looks like the blood just stays still above the block, my own vein disappears if I block it, as if the blood is sucked up by my heart or something like that... I really don't know which one is normal!

The other observation I've made is that my husband's pupils dilate only moderately in dim light but adrenal or norepinephrine surges don't affect his pupils. If he has the antibodies, it would make sense?

Thank you so much for this thread!