Desmopressin In The Treatment of Postural Orthostatic Tachycardia

Abstract

The long-term efficacy of desmopressin (DDAVP) in treatment of postural orthostatic tachycardia syndrome (POTS) patients remains unclear. We report our retrospective, single-center, long-term experience regarding the efficacy and adverse effect profile of DDAVP in the treatment of POTS patients. In this retrospective analysis, we reviewed the electronic charts for data in regards to patient demographics, orthostatic parameters, side effect profile, subjective response to therapy, and laboratory studies recorded for each clinical follow-up visit at our institution's Syncope and Autonomic Disorder Center. The response to DDAVP therapy was considered successful if the patient had both symptom relief in addition to an objective response in orthostatic hemodynamic parameters including (heart rate (HR) and systolic blood pressure (SBP)). Three hundred and fifty POTS patients were screened for evaluation in this study. Of the 350 patients, 72 patients who received DDAVP therapy were reviewed. Forty-eight patients from this group were able to tolerate the medication after careful dosage titration. Mean follow-up duration in this group of patients was 12 ± 2 months (10-14) months. DDAVP improved symptoms of orthostatic intolerance in 20 of 72 (28%) of the total patients or 20 of 48 (42%) of those who were able to tolerate the drug. Symptoms that improved the most included dizziness (48%), presyncope (38%), fatigue 18%, palpitations (33%), anxiety (42%), and syncope (20%). Symptom reduction correlated with a statistically significant improvement in standing HR after treatment with DDAVP compared with their baseline hemodynamic parameters (standing HR 102.33 ±12.67 versus 92.10±18.62, po0.03). The most common side effect was hyponatremia n ¼ 9, 20%). In the subgroup of patient with POTS who can tolerate oral DDAVP, there was notable improvement of standing HR, which correlated with improvement in clinical symptoms of orthostatic intolerance.