Low Dose Naltrexone (LDN)
Low‑dose naltrexone (LDN) is a low dose of naltrexone that is thought to briefly block opioid receptors to boost natural endorphins and support immune balance.
An illness often misdiagnosed, postural orthostatic tachycardia syndrome (POTS) is challenging to identify because no medication is specifically approved for the disease. POTS is a complicated condition with a range of symptoms that reflect difficulty regulating temperature, blood pressure, and heart rate. When patients shift from lying down to an upright position, or tilt their head more than 60 degrees, their bodies cannot compensate and heart rate increases in response.
Postural orthostatic tachycardia syndrome symptoms are a result of autonomic functions malfunctioning. Autonomic functions are unconscious processes the body is in charge of, like blood pressure, heart rate, digestion, and respiration. These problems stem from the body’s own innate survival operations dysfunctioning, making diagnosing POTS difficult. There is also significant presentation overlap with Mast Cell Activation Syndrome (MCAS) – another chronic disease that is often missed by medical providers. Roughly a third of POTS patients have both conditions.
Our Medications for Postural Orthostatic Tachycardia Syndrome (POTS)
About Postural Orthostatic Tachycardia Syndrome (POTS)
Types
POTS can be classified into three different types:
Hyperadrenergic
In hyperadrenergic POTS, the sympathetic (adrenergic) nervous system is overactivated. When patients stand, their bodies release too much norepinephrine, a neurotransmitter and a stress hormone. This can cause increased heart rate, blood pressure, and tremors that may worsen under stress.
Hypovolemic
In hypovolemic POTS, instead of extra norepinephrine complicating systems, it is a lack of circulating blood volume that causes heart rate disruption. Upon standing, the heart rate rises to maintain its output to support the body.
Neuropathic
In neuropathic POTS, nerve damage causes blood supply issues to the core and legs, making it hard for patients to maintain proper blood pressure against the pull of gravity. When patients stand, because their blood vessels don’t constrict the way they should, blood pools in their lower extremities and abdomen. The heart compensates by beating faster.
Symptoms
Characterized by the body’s difficulty to regulate temperature, blood pressure, and heart rate, postural orthostatic tachycardia syndrome symptoms can severely impair activities of daily life. POTS symptoms include:
- Heart palpitations
- Orthostatic intolerance
- Defined as an inability to tolerate standing upright. When patients stand, their nervous system cannot regulate blood flow, causing lightheadedness and weakness. Lying down alleviates the problem.
- Chronic muscle pain
- Heat intolerance
- Gastrointestinal issues
- May be confused with other motility disorders like irritable bowel syndrome (IBS).
- Fatigue
- Fainting
- Blurry vision
Management
Outside of postural orthostatic tachycardia syndrome supportive therapy, a huge component of living with a chronic condition is committing to non-pharmacologic measures. Exercises that involve endurance and resistance training help condition the heart and can decrease orthostatic intolerance. Increasing salt and fluids as well as elevating the head of the bed can have positive effects on blood volume and related symptoms. Compression garments are designed to decrease blood pooling in the lower half of the body while standing. Since many off-label medications can be hit or miss, these tools are critical for improving quality of life.
Therapies
Depending on the differential diagnosis, many hemodynamic medications can be used for postural orthostatic tachycardia syndrome treatment. These types of drugs, like the beta blocker propranolol, affect blood pressure and heart rate. Unfortunately, these therapies can often benefit one type of POTS but not another. Due to the unique nature of the syndrome, knowledgeable providers are extremely important for coordinating care. In addition, POTS patients can have symptoms of multiple subtypes, making medical management complex.
There are no FDA-approved pharmacotherapy options for POTS, meaning all drugs used to support patients are considered off-label therapies. Belmar Pharmacy compounds low dose naltrexone (LDN), a prominent medication for chronic conditions involving pain, autoimmunity, and autonomic dysfunction.
For POTS, low dose naltrexone (LDN) is considered a postural orthostatic tachycardia syndrome medication. Typically compounded at doses between 1 mg and 5 mg daily, LDN serves as an immune modulator and anti-inflammatory agent. LDN therapy can upregulate endorphins and encourage improved immune system performance.
Patients with chronic diseases like POTS can start LDN therapy for symptom management. LDN can diminish day-to-day pain, improve sleep, and positively influence cognition and state of mind. It may also help limit the unpredictable bouts of orthostatic intolerance. Medications that support stable, internal autonomic body systems can help POTS feel manageable.
Commonly Asked Questions About POTS
POTS stands for postural orthostatic tachycardia syndrome. Postural relates to standing upright from a seated or lying position. Tachycardia is defined as a rapid increase in heart rate. Syndrome is typically defined by a collection of symptoms that happen together.
Postural orthostatic tachycardia syndrome (POTS) is a complicated condition with a range of symptoms that reflect difficulty regulating temperature, blood pressure, and heart rate. When patients shift from lying down to an upright position, or tilt their head more than 60 degrees, their bodies cannot compensate and heart rate increases in response. Postural orthostatic tachycardia syndrome symptoms are a result of autonomic functions malfunctioning, such as blood pressure, heart rate, digestion, and respiration.
There are three main types of POTS that have different root malfunctions. In hyperadrenergic POTS, the sympathetic (adrenergic) nervous system is overactivated by an excess of norepinephrine. In hypovolemic POTS, it is a lack of circulating blood volume that causes heart rate disruption. In neuropathic POTS, nerve damage causes blood supply issues to the core and legs, making it hard for patients to maintain proper blood pressure against the pull of gravity.
