Beta-Blockers

  • Beta-blockers can help reduce orthostatic symptoms (specifically heart rate), and can be very helpful when used at lower doses for some (Raj et al., 2009).

  • More commonly used beta-blockers include propranolol and metoprolol.

  • Studies have found that higher doses may not be tolerated as well, which makes sense given that while beta-blockers do lower the heart rate, they can also lower blood pressure and reduce renin levels (Raj et al., 2009; Jacob et al., 1997).

  • It is also important to note that while helpful for some, there are some contraindications; one that providers should be mindful of includes diagnoses of MCAS which many in our community have.

  • Researchers have discovered they may exacerbate MCAS for some which is also important to consider when determining what medication options are best for a patient presenting with both MCAS and POTS (Cardet et al., 2014).

Sources:

Cardet, J.-C., Castells, M. C., & Hamilton, M. J. (2012). Immunology and clinical manifestations of non-clonal Mast cell activation syndrome. Current Allergy and Asthma Reports, 13(1), 10–18. https://doi.org/10.1007/s11882-012-0326-8

Jacob, G., Robertson, D., Mosqueda-Garcia, R., Ertl, A. C., Robertson, R. M., & Biaggioni, I. (1997). Hypovolemia in syncope and orthostatic intolerance role of the renin-angiotensin system. The American Journal of Medicine, 103(2), 128–133. https://doi.org/10.1016/s0002-9343(97)00133-2

Raj, S. R., Black, B. K., Biaggioni, I., Paranjape, S. Y., Ramirez, M., Dupont, W. D., & Robertson, D. (2009). Propranolol decreases tachycardia and improves symptoms in the postural tachycardia syndrome. Circulation, 120(9), 725–734. https://doi.org/10.1161/circulationaha.108.846501