title: Desmopressin acutely decreases tachycardia and improves symptoms in the postural tachycardia syndrome.
abstract: 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.
authors.affiliation: Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA.
authors.forename: Samuel T
authors.initials: ST
authors.lastname: Coffin
authors.forename: Bonnie K
authors.initials: BK
authors.lastname: Black
authors.forename: Italo
authors.initials: I
authors.lastname: Biaggioni
authors.forename: Sachin Y
authors.initials: SY
authors.lastname: Paranjape
authors.forename: Carlos
authors.initials: C
authors.lastname: Orozco
authors.forename: Phillip W
authors.initials: PW
authors.lastname: Black
authors.forename: William D
authors.initials: WD
authors.lastname: Dupont
authors.forename: David
authors.initials: D
authors.lastname: Robertson
authors.forename: Satish R
authors.initials: SR
authors.lastname: Raj
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D050034:Antidiuretic Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001341:Autonomic Nervous System / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D003894:Deamino Arginine Vasopressin / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D006305:Health Status Indicators; D006339:Heart Rate / Q000187:drug effects; D006490:Hemostatics / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D010865:Pilot Projects; D054972:Postural Orthostatic Tachycardia Syndrome / Q000188:drug therapy*; D016037:Single-Blind Method
chemical_list: D050034:Antidiuretic Agents; D006490:Hemostatics; D003894:Deamino Arginine Vasopressin