Trial Report Desmopressin acutely decreases tachycardia and improves symptoms in the postural tachycardia syndrome, 2012, Coffin et al

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Desmopressin acutely decreases tachycardia and improves symptoms in the postural tachycardia syndrome

Coffin, Samuel T.; Black, Bonnie K.; Biaggioni, Italo; Paranjape, Sachin Y.; Orozco, Carlos; Black, Phillip W.; Dupont, William D.; Robertson, David; Raj, Satish R.

Background
Postural tachycardia syndrome (POTS) induces disabling chronic orthostatic intolerance with an excessive increase in heart rate on standing, and many patients with POTS have low blood volume. Increasing blood volume is a promising approach to this problem.

Objective
 To test the hypothesis that desmopressin (DDAVP) will attenuate the tachycardia and improve symptom burden in patients with POTS.

Methods
 In this protocol, patients with POTS (n = 30) underwent acute drug trials with DDAVP 0.2 mg orally and placebo, on separate mornings, in a randomized crossover design. Blood pressure, heart rate, and symptoms were assessed while seated and after standing for up to 10 minutes prior to and hourly for 4 hours following study drug.

Results
 The standing heart rate was significantly lower following DDAVP than placebo (101.9 ± 14.5 beats/min vs 109.2 ± 17.4 beats/min; P <.001). Standing blood pressure was not affected (P = .28). The symptom burden improved with DDAVP (from a score of 18 ± 18 arbitrary units [AU] to 13 ± 15 AU at 2 hours) compared with placebo (from 18 ± 17 AU to 19 ± 16 AU; P = .010).

Conclusions
Oral DDAVP significantly attenuated tachycardia and improved symptoms in POTS. The safety profile of this approach would need to be examined before it can be recommended for routine treatment of these patients.

Web | DOI | PMC | PDF | Heart Rhythm | Open Access
 
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Just replying to bump

I note the abstract ends with a line about needing to review the safe profile of desmopressin.

What’s involved with doing that? Is there already literature

Is it a drug that has been used for other purposes in the past for example?
 
Citations in PubMed

Mentioned in Perioperative and anesthetic considerations for post-acute sequelae of COVID PASC/long COVID (2025) —

Postural orthostatic tachycardia syndrome (POTS), a form of dysautonomia, is characterized by an increase in heart rate of at least 30 beats per minute upon standing, without a drop in blood pressure. One prevailing theory for POTS’s pathophysiology involves an excessive adrenergic response, resulting in heightened sympathetic activity (Sebastian et al. 2022). Given this, anesthesiologists must use epinephrine cautiously in PASC patients with dysautonomia during surgery to avoid exacerbating autonomic dysfunction and causing unpredictable hemodynamic effects (Society For Endocrinology 2013). Alternatives like phenylephrine and vasopressin have demonstrated benefits in improving orthostatic tolerance and stabilizing hemodynamics in POTS patients and may be preferable during surgical procedures (Stewart et al. 2002; Coffin et al. 2012). However, ephedrine should be avoided as it can both block the reuptake of norepinephrine and trigger its release from nerve endings, potentially aggravating POTS symptoms.
Click to expand...
 
bobbler said:
I note the abstract ends with a line about needing to review the safe profile of desmopressin.

What’s involved with doing that? Is there already literature

Is it a drug that has been used for other purposes in the past for example?
Click to expand...
Yes, including bedwetting in children.

I took it as an adult with moderate ME (0.1mg tablet twice a day), 10 days later crashed into severe and have not recovered.
For comparison, https://bnf.nice.org.uk/drugs/desmopressin/ mentions 0.2-0.4mg tablet(s) once a day for primary nocturnal enuresis in children 5-17 yo.
 
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