Postural orthostatic tachycardia syndrome (POTS) is a condition affecting the body’s automatic control systems, causing a racing heart and a range of troubling symptoms when standing up. While there’s no cure yet, a combination of lifestyle changes and targeted treatments can help many people regain control of their daily lives and reduce the burden of symptoms.

Understanding Treatment Goals for POTS

The main goal when treating postural orthostatic tachycardia syndrome is not simply to slow down a racing heart, but to help people live fuller, more comfortable lives. Treatment focuses on managing the uncomfortable symptoms that occur when standing up—such as dizziness, fatigue, rapid heartbeat, and brain fog—so that everyday activities become more manageable.^[1] Because POTS affects each person differently, treatment plans need to be tailored to individual symptoms, triggers, and overall health condition.

Many people with POTS can experience improvement in their quality of life through adjustments in diet, exercise routines, and daily habits, though some may also need medications to help control their symptoms.^[1] The approach to treatment depends on several factors, including which type of POTS a person has, how severe their symptoms are, and whether they have other health conditions alongside POTS. For instance, someone who has hypovolemia (low blood volume) may need different strategies compared to someone whose POTS is linked to excessive release of stress hormones.

Treatment strategies have been developed over years of clinical experience and research, even though large, long-term controlled trials comparing different approaches are still limited.^[11] Medical societies and expert physicians have established recommendations based on available evidence and practical experience treating thousands of patients. Importantly, the treatment journey often requires patience and persistence, as finding the right combination of strategies can take time. Most people with POTS see symptoms come and go over months or years, and many experience gradual improvement with consistent treatment.^[1]

Standard Treatment Approaches

The foundation of POTS treatment begins with changes to daily habits and lifestyle, which many doctors recommend trying before or alongside medications. These non-drug approaches can be surprisingly effective for many people and carry no risk of medication side effects.^[3]

Increasing Fluid and Salt Intake

One of the most important treatment strategies involves drinking more water and consuming more salt than normally recommended for healthy adults. This approach works because many people with POTS have lower than normal blood volume, which means less blood is circulating through their body.^[1] When blood volume is low, it becomes even harder for the body to pump enough blood to the brain when standing up, causing dizziness and other symptoms.

Doctors typically recommend that people with POTS drink approximately two to three liters of fluids per day—that’s roughly eight to twelve cups of water, milk, or electrolyte drinks.^[1] But drinking water alone isn’t enough. The body needs salt to hold onto that fluid in the blood vessels. Most people with POTS need to consume between three and ten grams of salt daily, which is much more than the standard dietary recommendation of 2.3 grams per day for healthy adults.^[20] This higher salt intake is specifically for people with POTS and should only be done under medical supervision.

There are several ways to increase salt intake. Some people take salt tablets like SaltSticks or Thermotabs, which provide a measured dose of sodium. Others prefer to eat naturally salty foods such as broth, tomato juice, pickles, olives, or cured meats, or simply add more salt to their regular meals.^[16] Medical-grade oral rehydration salts like NormaLyte have been shown to be particularly effective, as they provide the right balance of salt and water to maximize absorption and have been clinically proven to help manage POTS symptoms.^[16]

Using Compression Garments

Compression clothing helps push blood from the legs back toward the heart and brain, fighting against gravity’s pull. When standing, blood tends to pool in the lower body in people with POTS, which contributes to dizziness and other symptoms.^[1] Compression garments squeeze the blood vessels in the legs and abdomen, helping to reduce this pooling effect.

Medical compression stockings or socks with 20 to 30 millimeters of mercury (mm Hg) pressure are commonly recommended.^[16] These come in various styles, including knee-high socks, footless calf sleeves, full leggings, and compression shorts. Research has shown that wearing an abdominal binder (a girdle-like garment) combined with knee-high compression socks provides particularly good results for people with POTS.^[10] These garments are especially helpful during periods when you need to stand for longer times, though they can be worn throughout the day.

Dietary Adjustments

Many people with POTS notice that their symptoms worsen after eating large meals. This happens because blood flow is redirected to help with digestion, leaving less blood available for the brain and other organs.^[20] To minimize this effect, doctors recommend eating several smaller meals throughout the day instead of two or three large ones.

The type of food matters too. Some people find that meals high in refined carbohydrates—like white bread, white rice, or sugary foods—make their symptoms worse.^[20] Choosing meals with lean protein (such as chicken, fish, or yogurt) and complex carbohydrates (like whole grains) along with healthy fats may help keep symptoms more stable. Some individuals with POTS also have sensitivities to gluten or dairy products, which can worsen digestive symptoms and fatigue, though this varies from person to person.^[20]

Gradual Exercise Programs

Although it might seem counterintuitive when you’re feeling exhausted and dizzy, carefully planned exercise is considered a cornerstone of POTS treatment.^[10] The key is starting very gently and building up slowly over time. Exercise helps improve blood circulation, strengthens the heart, and can reduce the severity of symptoms over several months.

The most important principle is to begin with exercises done while lying down or reclined, since these positions don’t trigger POTS symptoms. Swimming, rowing machines, or recumbent bicycles are excellent starting points.^[10] As tolerance improves over weeks and months, people can gradually add more upright activities. The goal is to eventually work up to 30 to 45 minutes of exercise most days of the week, but this progression must happen slowly and under medical guidance to avoid making symptoms worse.

Medications for POTS

When lifestyle changes alone don’t provide enough relief, doctors may prescribe medications to help manage POTS symptoms. Several different types of drugs can be used, depending on which symptoms are most troublesome and what seems to be driving the condition in each person.^[11]

Fludrocortisone (brand name Florinef) is a medication that helps the kidneys retain more salt and water, which increases blood volume. By expanding the amount of blood in circulation, this drug helps reduce dizziness and improve blood flow to the brain when standing.^[11] It’s often one of the first medications tried, particularly for people with low blood volume. However, it requires careful monitoring because it can cause the body to lose potassium, so people taking this drug may need potassium supplements.

Midodrine is a medication that causes blood vessels to constrict or tighten. By making blood vessels squeeze more, it helps prevent blood from pooling in the legs and abdomen when standing.^[11] This medication is taken several times throughout the day, typically every four hours while awake. Because it raises blood pressure, it shouldn’t be taken when lying down, as this could cause blood pressure to become too high in that position.

Beta-blockers are medications commonly used for heart conditions that can also help some people with POTS by slowing down the heart rate. Drugs like propranolol or metoprolol may be prescribed when the racing heart itself is a major source of distress.^[11] However, these medications don’t work for everyone with POTS, and in some people they can actually make fatigue worse, so they need to be carefully monitored.

Ivabradine is a newer medication that specifically slows heart rate without affecting blood pressure. It works by blocking certain channels in the heart that control the speed of heartbeat.^[11] This can be particularly helpful for people whose main symptom is an uncomfortably fast heart rate when standing. Studies have shown that ivabradine can improve symptoms and quality of life in people with POTS, though it’s not yet approved by all regulatory agencies specifically for this condition.

For people with the hyperadrenergic subtype of POTS—where there are high levels of stress hormones causing symptoms—medications that block the effects of these hormones may be helpful. These can include certain beta-blockers or medications like clonidine that reduce the release of stress hormones.^[11]

Some people with POTS also experience improvement with selective serotonin reuptake inhibitors (SSRIs), medications commonly used to treat depression and anxiety. While POTS is not a psychiatric condition, these medications may help by affecting blood vessel tone and possibly reducing some of the stress response that worsens symptoms.^[3] Additionally, many people with POTS develop anxiety or depression as a result of their illness, and treating these conditions can improve overall quality of life.

In severe cases where other treatments haven’t worked, some doctors may recommend intravenous (IV) saline infusions—essentially delivering salt water directly into the bloodstream to rapidly expand blood volume.^[11] This approach can provide temporary relief during severe symptom flares but isn’t practical as a daily treatment for most people.

Emerging Treatments Being Studied in Research

Because POTS affects so many people and current treatments don’t work for everyone, researchers are actively exploring new approaches to manage this condition. While no major clinical trials testing new drugs specifically for POTS are widely reported in the available medical literature, several areas of investigation show promise based on understanding the underlying mechanisms of the disease.

Understanding Different Treatment Targets

Scientists are learning more about why POTS develops in different people, which helps identify new potential treatment approaches. Some research focuses on understanding the role of autoimmunity—where the body’s immune system mistakenly attacks its own tissues. Some people with POTS have antibodies in their blood that may interfere with the normal function of the autonomic nervous system, which controls automatic body functions like heart rate and blood pressure.^[2]

This has led to interest in therapies that modify the immune system. Some researchers have explored the use of intravenous immunoglobulin (IVIg), a treatment that involves giving concentrated antibodies from healthy donors to help reset the immune system. While this approach has been used in some people with severe POTS who show signs of autoimmune problems, more research is needed to determine which patients might benefit and how effective it truly is.

Investigating Small Fiber Neuropathy Treatments

About half of people with POTS have damage to small nerve fibers that control sweating and blood vessel constriction.^[2] This condition is called small fiber neuropathy, and it contributes to many POTS symptoms. Researchers are investigating whether treating this nerve damage could improve POTS symptoms. Some studies are looking at whether medications used for other types of nerve pain, such as gabapentin or pregabalin, might help people with POTS who have small fiber neuropathy.

Novel Approaches to Blood Volume Expansion

Since low blood volume is a key problem in POTS, researchers continue to explore better ways to expand blood volume beyond just salt and fluid intake. Some studies are examining whether certain hormones that help the body retain water and salt might be useful in treatment. Other researchers are looking at whether specific formulations of oral rehydration solutions—similar to those used in developing countries to treat dehydration from infections—might be optimized specifically for POTS patients.

Targeted Physical Therapy Programs

While exercise is already part of standard treatment, researchers are developing more specific physical therapy protocols designed just for POTS. These programs carefully map out how to progress from very gentle exercises to more challenging ones over several months.^[17] Some research centers are testing whether adding particular types of movements—such as pumping the leg muscles before standing or doing special breathing exercises—can provide additional benefit. Physical therapists with expertise in POTS are also developing techniques to help patients manage symptoms during daily activities like showering or preparing meals.

Research on POTS After Viral Infections

The COVID-19 pandemic led to a dramatic increase in the number of people developing POTS, with experts estimating that the POTS population doubled after the pandemic began.^[2] This has intensified research into understanding why some people develop POTS after viral infections and whether these cases might respond to specific treatments. Some research institutions are conducting trials to test whether treatments that reduce inflammation or help the body clear viral remnants might benefit people with post-viral POTS, though results are still preliminary.

Researchers are also studying whether people who develop POTS after COVID-19 have different characteristics or treatment responses compared to people whose POTS began in other ways. This work may help doctors better predict which treatments will work for which patients.

Where Research is Happening

Many major medical centers in the United States, including Vanderbilt University Medical Center, Mayo Clinic, Johns Hopkins, and Cleveland Clinic, have specialized programs studying POTS.^[13] In Europe, centers in countries like Sweden are also conducting POTS research. These institutions often recruit patients for clinical studies testing new approaches to diagnosis and treatment. People interested in participating in research can ask their doctors about clinical trials or check research registries that list ongoing studies.

Most Common Treatment Methods

• Lifestyle and Dietary Modifications
  • Increased fluid intake of 2-3 liters per day to expand blood volume
  • Higher salt consumption (3-10 grams daily) to help retain fluids
  • Eating smaller, more frequent meals to avoid blood pooling during digestion
  • Reducing refined carbohydrates and choosing lean proteins
  • Using oral rehydration solutions with optimized electrolyte balance
• Compression Therapy
  • Medical-grade compression stockings with 20-30 mm Hg pressure
  • Abdominal binders to prevent blood pooling in the abdomen
  • Compression garments worn during standing or active periods
• Exercise and Physical Therapy
  • Recumbent or horizontal exercise programs starting with swimming or rowing
  • Gradual progression to upright activities over several months
  • Goal of 30-45 minutes of exercise most days per week
  • Specialized physical therapy techniques for daily activity management
  • Leg muscle pumping exercises before standing
• Medications to Increase Blood Volume
  • Fludrocortisone to help kidneys retain salt and water
  • IV saline infusions for severe symptom flares
• Medications to Regulate Heart Rate and Blood Vessels
  • Midodrine to constrict blood vessels and prevent pooling
  • Beta-blockers like propranolol or metoprolol to slow heart rate
  • Ivabradine to specifically reduce heart rate without affecting blood pressure
  • Clonidine to reduce excessive stress hormone release in hyperadrenergic POTS
• Medications for Associated Symptoms
  • SSRIs to help with blood vessel tone and mood symptoms
  • Medications for nerve pain in those with small fiber neuropathy
• Positional Strategies
  • Elevating the head of the bed to help the body adapt to positional changes
  • Avoiding prolonged standing and sitting when possible
  • Learning techniques to squat, cross legs, or perform muscle contractions when feeling faint
  • Drinking water rapidly before standing in the morning