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Utilisation of medications to reduce symptoms in children with postural orthostatic tachycardia syndrome

Published online by Cambridge University Press:  06 August 2018

Jeffrey R. Boris Open the ORCID record for Jeffrey R. Boris [Opens in a new window]  and
Thomas Bernadzikowski
Jeffrey R. Boris*
Affiliation:
Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
Thomas Bernadzikowski
Affiliation:
Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
*
Author for correspondence: J. R. Boris, MD, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Division of Cardiology, Philadelphia, PA 19104, USA. Tel: 215 590 3180; Fax: 267 426 5324; E-mail: borisj@email.chop.edu
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Abstract

Background

Postural orthostatic tachycardia syndrome encompasses multiple disabling symptoms that interfere with daily activities. Non-pharmacologic approaches can be insufficient and can require adjunctive medications to manage symptoms. Minimal data exist in the literature on medication outcomes in these patients. We reviewed our database for medication management outcomes.

Materials and Methods

Patients aged 18 years and younger at initial diagnosis met the inclusion criteria. All prescribed patient medications were extracted from the electronic health record, excluding medications for unrelated symptoms or comorbid diseases. Medications were grouped by symptom class consistent with our programme utilisation protocol. Within symptom classification, therapy was deemed successful when a specific dose was prescribed at least five consecutive times without changes; this was confirmed by chart review. Individual medications and overall percentage of successful therapies within symptom classifications were assessed, with further analysis by gender. t-Test, χ2, and Mann–Whitney U-test were used to assess for differences in specific variables, as appropriate.

Results

A total of 708 patients met the study criteria. The percentage of patients with effective therapy by symptom includes light-headedness (52.2%), headache (48.2%), nausea (39.1%), dysmotility (43.4%), pain (53.4%), and insomnia (42.8%). Insomnia therapy was better for females; all other therapies showed no gender difference. The median number of therapies prescribed per patient per symptom was 2 for light-headedness, headache, and insomnia, and 1 for nausea, dysmotility, and pain.

Discussion

Symptoms associated with this disorder can be effectively managed with various medications. Further randomised studies are needed to better ascertain true efficacy compared with placebo.

Keywords

Dysautonomialight-headednessheadachedysmotilityinsomnia
Type
Original Article
Information
Cardiology in the Young , Volume 28 , Issue 12 , December 2018 , pp. 1386 - 1392
Copyright
© Cambridge University Press 2018 

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References

1. Arnold, AC, Ng, J, Raj, SR. Postural tachycardia syndrome – diagnosis, physiology, and prognosis. Auton Neurosci 2018; https://doi.org/10.1016/j.autneu.2018.02.005.Google Scholar
2. Sandroni, P, Opfer-Gehrking, TL, McPhee, BR, Low, PA. Postural tachycardia syndrome: clinical features and follow-up study. Mayo Clin Proc 1999; 74: 1106–1110.Google Scholar
3. Stewart, JM, Boris, JR, Chelimsky, G, et al. Pediatric disorders of orthostatic intolerance. Paediatrics 2018; 141 https://doi.org/10.1542/peds.2017-1673.Google Scholar
4. George, SA, Bivens, TB, Howden, EJ, Saleem, Y, Hendrickson, D, Fu, Q, Levine, BD. The international POTS registry: evaluating the efficacy of an exercise training intervention in a community setting. Heart Rhythm 2016; 13: 943–950.Google Scholar
5. Kanjwal, K, Saeed, B, Karabin, B, Kanjwal, Y, Grubb, BP. Use of methylphenidate in the treatment of patients suffering from refractory postural tachycardia syndrome. Am J Ther 2012; 19: 2–6.Google Scholar
6. Raj, SR, Black, BK, Biaggioni, I, Paranjape, SY, Ramirez, M, Dupont, WD, Robertson, D. Propranolol decreases tachycardia and improves symptoms in the postural tachycardia syndrome: less is more. Circulation 2009; 120: 725–734.Google Scholar
7. Grubb, BP. Postural tachycardia syndrome. Circulation 2008; 117: 2814–2817.Google Scholar
8. Boris, JR. The role of the cardiologist in the evaluation of dysautonomia. Cardiol Young 2010; 20 (Suppl 3): 135–139.Google Scholar
9. Harris, PA, Taylor, R, Thielke, R, Payne, J, Gonzalez, N, Conde, JG. Research electronic data capture (REDCap) – a metadata-drive methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42: 377–381.Google Scholar
10. Freitas, J, Santos, R, Azevedo, E, Costa, O, Carvalho, M, de Freitas, AF. Clinical improvement in patients with orthostatic intolerance after treatment with bisoprolol and fludrocortisone. Clin Auton Res 2000; 10: 293–299.Google Scholar
11. Hoeldtke, RD, Horvath, GG, Bryner, KD, Hobbs, GR. Treatment of orthostatic hypotension with midodrine and octreotide. J Clin Endocrinol Metab 1998; 83: 339–343.Google Scholar
12. Lai, CC, Fischer, PR, Brands, CK, Fisher, JL, Porter, CB, Driscoll, SW, Graner, KK. Outcomes in adolescents with postural orthostatic tachycardia syndrome treated with midodrine and beta-blockers. Pacing Clin Electrophysiol 2009; 32: 234–238.Google Scholar
13. Chen, L, Wang, L, Sun, J, Qin, J, Tang, C, Jin, H, Du, J. Midodrine hydrochloride is effective in the treatment of children with postural orthostatic tachycardia syndrome. Circ J 2011; 75: 927–931.Google Scholar
14. Coffin, ST, Black, BK, Biaggioni, I, Paranjape, SY, Orozco, C, Black, PW, Dupont, WD, Roberson, D, Raj, SR. Desmopressin acutely decreases tachycardia and improves symptoms in the postural tachycardia syndrome. Heart Rhythm 2012; 9: 1484–1490.Google Scholar
15. Gachoka, D, Kanjwal, K, Karabin, B, Grubb, BP. Desmopressin in the treatment of postural orthostatic tachycardia. J Innov Card Rhythm Management 2015; 6: 2222–2226.Google Scholar
16. Hoeldtke, RD, Davis, KM, Joseph, J, Gonzales, R, Panidis, IP, Friedman, AC. Hemodynamic effects of octreotide in patients with autonomic neuropathy. Circulation 1991; 84: 168–176.Google Scholar
17. Kanjwal, K, Saeed, B, Karabin, B, Kanjwal, Y, Grubb, BP. Use of octreotide in the treatment of refractory orthostatic intolerance. Am J Ther 2012; 19: 7–10.Google Scholar
18. Kanjwal, K, Saeed, B, Karabin, B, Kanjwal, Y, Sheikh, M, Grubb, BP. Erythropoietin in the treatment of postural orthostatic tachycardia syndrome. Am J Ther 2012; 19: 92–95.Google Scholar
19. Mar, PL, Raj, V, Black, BK, Biaggioni, I, Shibao, CA, Paranjape, SY, Dupont, WD, Robertson, D, Raj, SR. Acute hemodynamic effects of a selective serotonin reuptake inhibitor in postural tachycardia syndrome: a randomized, crossover trial. J Psychopharmacol 2014; 28: 155–161.Google Scholar
20. Gaffney, FA, Lane, LB, Pettinger, W, Blomqvist, CG. Effects of long-term clonidine administration on the hemodynamic and neuroendocrine postural responses of patients with dysautonomia. Chest 1983; 83 (2 Suppl): 436–438.Google Scholar
21. Raj, SR, Black, BK, Biaggioni, I, Harris, PA, Robertson, D. Acetylcholinesterase inhibition improves tachycardia in postural tachycardia syndrome. Circulation 2005; 111: 2734–2740.Google Scholar
22. Gales, BJ, Gales, MA. Pyridostigmine in the treatment of orthostatic intolerance. Am Pharmacother 2007; 41: 314–318.Google Scholar
23. Kanjwal, K, Karabain, B, Sheikh, M, Elmer, L, Kanjwal, Y, Saeed, B, Grubb, BP. Pyridostigmine in the treatment of postural orthostatic tachycardia: a single-center experience. Pacing Clin Electrophysiol 2011; 34: 750–755.Google Scholar
24. Powers, SW, Coffey, CS, Chamberlin, LA, Ecklund, DJ, Klingner, EA, Yankey, JW, Korbee, LL, Porter, LL, Hershey, AD, CHAMP Investigators. Trial of amitriptyline, topiramate, and placebo for pediatric migraine. New Engl J Med 2017; 376: 115–124.Google Scholar
25. Finniss, DG, Kaptchuk, TJ, Miller, F, Benedetti, F. Biological, clinical, and ethical advances of placebo effects. Lancet 2010; 375: 686–695.Google Scholar
26. Oigaard, A. The motor-stimulating effect of metoclopramide and pyridostigmine bromide in normal man and laparotomized patients. A combined study of duodenal Electric and motor activity. Scand J Gastroenterol 1975; 10: 65–71.Google Scholar
27. Manini, ML, Camilleri, M, Grothe, R, Di Lorenzo, C. Application of pyridostigmine in pediatric gastrointestinal motility disorders: a case series. Paediatr Drugs 2017; 20: 173–180.Google Scholar
28. Coffin, ST, Black, BK, Biaggioni, I, Paranjape, SY, Orozco, C, Black, PW, Dupont, WD, Robertson, D, Raj, SR. Desmopressin acutely decreases tachycardia and improves symptoms in the postural tachycardia syndrome. Heart Rhythm 2012; 9: 1484–1490.Google Scholar