Living with Postural Orthostatic Tachycardia Syndrome (POTS) can feel like a daily balancing act. Finding the right treatment plan often means trying different medications, adjusting doses, and working closely with your healthcare team.
But as many patients quickly learn, medications that help manage POTS can sometimes come with side effects — some mild and temporary, others that require medical attention.
Understanding which side effects are normal and which are warning signs can help you stay safe, informed, and confident throughout your treatment journey
Understanding How POTS Medications Work
POTS affects the autonomic nervous system — the part of the body that controls automatic functions like heart rate, blood pressure, and digestion. Because everyone’s symptoms and triggers differ, treatment is highly individualized. These medications are often used off-label and should be prescribed under specialist supervision. (Based on studies from JACC (2018), Dysautonomia International, and AAS guidelines.)
There’s no single “POTS medication.” Instead, doctors often prescribe drugs that target specific symptoms, such as rapid heartbeat, low blood pressure, or blood pooling in the legs. Common medication categories include:
- Beta-blockers (e.g., propranolol, metoprolol): Slow down heart rate and reduce adrenaline response.
- Vasoconstrictors (e.g., midodrine): Tighten blood vessels to improve blood flow to the brain.
- Volume expanders (e.g., fludrocortisone): Help retain salt and water to increase blood volume.
- Stimulants (e.g., modafinil, methylphenidate): Improve alertness and fatigue in select patients.
- SSRIs or SNRIs (e.g., sertraline, venlafaxine): Support autonomic regulation and reduce anxiety symptoms.
Each category can play an important role, but each also comes with its own side effect profile.
Common (and Often Normal) Side Effects
When you first start medication for POTS, it’s common to experience some mild and short-term changes as your body adjusts. These effects often lessen over time or disappear as your dosage stabilizes.
1. Fatigue or Low Energy
Many medications that regulate heart rate, especially beta-blockers, can make you feel tired or sluggish.
This happens because they lower adrenaline and slow your pulse, reducing energy levels temporarily.
What helps: Start with small doses, take medication with food, and discuss timing with your doctor — sometimes taking it at night reduces daytime fatigue.
2. Lightheadedness or Dizziness
Ironically, drugs meant to manage POTS can initially worsen dizziness in some patients. This often happens during early dose adjustments, especially with fludrocortisone or midodrine.
What helps: Stay hydrated, increase salt (if approved by your physician), and rise slowly from sitting to standing.
3. Mild Headaches
A mild, pressure-type headache can occur with vasoconstrictors like midodrine, as they tighten blood vessels.
What helps: Avoid caffeine around dosing time and monitor whether the headache fades as your body adapts. Report persistent or severe pain.
4. Stomach Upset or Nausea
Certain medications can irritate the stomach or affect digestion. Beta-blockers and SSRIs are common culprits.
What helps: Take with meals and maintain small, frequent snacks throughout the day.
5. Increased Urination or Thirst
Fludrocortisone encourages your body to retain sodium, which can lead to more frequent urination and thirst.
What helps: Keep track of hydration, and ensure your doctor regularly checks your electrolytes.
6. Mild Anxiety or Jitters
Some medications, especially stimulants or those that affect adrenaline, can cause a jittery feeling.
What helps: Avoid caffeine, monitor sleep, and share feedback with your doctor to fine-tune your dose.
Side Effects That May Need Attention
While some side effects are expected, others may signal that your medication or dosage isn’t the right fit. It’s important to recognize early warning signs and communicate them clearly to your care team.
1. Severe Drop in Blood Pressure
If you feel extreme weakness, dizziness, or blurry vision — especially upon standing — your blood pressure may be dropping too low.
This can happen with beta-blockers or vasodilating drugs.
Seek prompt medical review. Your doctor may need to adjust timing or reduce the dose.
2. Rapid or Irregular Heartbeat
Ironically, medications used to regulate POTS-related heart rate can sometimes overshoot the target, causing palpitations or irregular beats.
Monitor symptoms closely — if you feel chest pain, fluttering, or shortness of breath, contact your provider right away.
3. Significant Mood Changes
SSRIs and SNRIs can sometimes alter mood or sleep patterns. If you experience new anxiety, restlessness, or sadness, don’t stop medication suddenly — talk to your doctor first to plan a safe adjustment.
4. Swelling or Weight Gain
Fludrocortisone, which helps expand blood volume, may cause water retention, puffy ankles, or sudden weight gain.
Important: Notify your healthcare provider — they may monitor potassium levels or adjust salt intake.
5. Tingling or Numbness
Rarely, patients report sensations like tingling hands, feet, or lips — sometimes linked to blood flow changes or nerve sensitivity.
If these persist or worsen, seek evaluation to rule out other causes.
6. Allergic Reactions
Any swelling of the lips, face, or throat, or a rash accompanied by difficulty breathing, could indicate an allergic reaction.
Stop the medication and seek emergency care immediately.
How to Track and Manage Side Effects
Managing POTS is a team effort between you and your healthcare provider. Keeping a clear record of symptoms can make it easier to distinguish normal adjustments from concerning changes.
1. Keep a Medication Journal
Write down:
- Medication name and dose
- Time taken
- Any side effects or changes in symptoms
Patterns often appear after a few days, helping your doctor fine-tune your plan.
2. Don’t Adjust Doses on Your Own
Even small changes can alter your heart rate or blood pressure significantly. Always consult your provider before increasing, skipping, or stopping any medication.
3. Combine Medication With Lifestyle Changes
Medications work best alongside hydration, compression garments, gentle exercise, and salt intake adjustments.
These can sometimes reduce the need for higher doses and help limit side effects.
4. Regular Monitoring
Your care team might check:
- Blood pressure and pulse (lying, sitting, and standing)
- Electrolytes and kidney function
- Weight and fluid retention
- Symptom improvement over time
These reviews help ensure medications are working safely and effectively.
When to Call Your Doctor
You should always reach out to your doctor if you experience:
- Fainting or near-fainting spells
- Unexplained swelling or sudden weight changes
- Irregular heartbeat or chest discomfort
- Severe fatigue that affects daily functioning
- New or worsening depression, confusion, or anxiety
- Persistent headaches, nausea, or digestive issues
Never feel like you are “bothering” your care team — side effects are part of finding the right balance, and reporting them early helps prevent complications.
Finding the Right Balance Takes Time
For many people with POTS, it can take weeks or months to find the right combination of medications and lifestyle habits that provide real relief. What works for one person may not work for another — and that’s completely normal.
Your body’s response can change over time, too, so ongoing communication is key.
The good news is that with persistence, medical guidance, and self-awareness, most patients eventually find a regimen that helps them return to school, work, or the activities they love.
Final Thoughts
POTS medication side effects can be frustrating, but they don’t have to derail your progress.
Some side effects — like mild fatigue, headaches, or thirst — are normal and fade as your body adapts. Others, such as severe dizziness, swelling, or mood shifts, need attention.
The most important step is to stay proactive:
- Keep open communication with your healthcare provider.
- Track your body’s responses honestly.
- Never stop or switch medication on your own.
At Diekman Dysautonomia, we understand that your journey is unique. Dr. Sarah Diekman combines medical expertise with lived experience in managing POTS to ensure that your care is guided by science, empathy, and shared understanding.
If you’re experiencing unusual side effects or struggling to find the right balance, our team is here to help you adjust, adapt, and thrive.
Schedule a consultation today — your voice will be heard, and your treatment plan will be tailored to you.
