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Dysautonomia Treatments

DYSAUTONOMIA TREATMENTS

Please add, edit, update, or modify as needed.

This page is in the process of being updated as of 7-17-09.

Back to Dysautonomia & Autonomic Dysfunction Index


  • Pros: Ease of dosing, often the first choice for Dysautonomia patients, considerable evidence suggests that the drug is one of the most effective in treating orthostatic intolerance, helps blood vessels to contrict more easily, long duration of action, etc.
  • Cons: Effectiveness depends upon salt intake, can deplete the body of essential electrolytes (like potassium, calcium and magnesium), increases intercranial pressure, extreme caution in chiari patients, can cause severe headaches, can reduce plasma renin activity known to correlate with hypovolemia, etc.
  • Common Side Effects: difficulty sleeping, lightheadedness, headache, appetite changes, nausea, increased sweating, and nervousness.

 

  • Beta Blockers:
  • Pros: Ease of dosing, especially useful in patients with hypersensitivity to norepinephrine, etc.
  • Cons: Can worsen hypotension, can reduce plasma renin activity known to correlate with hypovolemia, use with caution in patients with mast-cell activation disorders, etc.
  • Common Side Effects: insomnia, drowsiness, decreased sex drive, nervousness, depression, nightmares, upset stomach, lightheadedness, constipation, and diarrhea.

 

  • Pros: Can be used on the as-needed bases, decreases blood pooling, causes blood vessels to constrict allowing more blood into the upper parts of the body, etc.
  • Cons: Daily dosing is inconvienent, can cause supine hypertension, wears off quickly, use with caution in patients with suspected LQTS, etc.
  • Common Side Effects: chills, goosebumps, tingling, frequent urination, headaches, and supine hypertension.

 

  • Selective Serotonin Reuptake Inhibitors {SSRI's}:
  • Pros: Ease of dosing, Aids central serotonin regulation to help control blood pressure, supress the  sympathetic nervous system, treat any existing anxiety/panic symptoms, helpful in Dysautonomia patients in very small dosages, etc.
  • Cons: Contains a "black box" warning for increased risk suicidality, normally used for depression, etc.
  • Common Side Effects: weight changes, stomach upset, insomnia, drowsiness, decreased sex drive, increased appetite, nausea, constipation, cold symptoms, increased sweating, and headaches.

 

  • Serotonin Norepinephrine Reuptake Inhibitors {SNRI's}:
  • Pros: Ease of dosing, aids central serotonin regulation to help control blood pressure, supress the sympathetic nervous system, treat any existing anxiety/panic symptoms, especially effective in treating hyperadrenergenic states, etc.
  • Cons: Contains a "black box" warning for increased risk suicidality, normally used for depression, etc
  • Common Side Effects: weight loss, insomnia, drowsiness, decreased appetite, nausea, constipation, increased sweating, and tremors.

 

  • Pros: Can be used on the as-needed bases, increases orthostatic blood pressure without increasing supine blood pressure, inhibits the breakdown of acetylcholine promoting parasympathetic nervous system activity, can be helpful in patients with autoimmune Dysautonomia, can be mildly helpful in patients with delayed gastric emptying, etc.
  • Cons: Daily dosing is inconvienent, wears off quickly, etc.
  • Common Side Effects: increased saliva, increased sweating, increased urination, watery eyes, stomach upset, stomach pain, nausea, warmth, tingling, and diarrhea.

 

  • Pros: Inhibits the release of epinephrine and norepinephrine, counteracts parasympathetic activity, helpful in severe bradycardia, can be an effective alternative to a pacemaker, etc.
  • Cons: Life-threatening side effects, use with caution in patients with suspected LQTS, etc.
  • Common Side Effects: drowsiness, stomach pain, lightheadedness, nausea, headache, constipation, and diarrhea.

 

  • Benzodiazepines:
  • Pros: Can be used on the as-needed bases, helpful for relieving panic symptoms, diazepam in particular is often used in treatment of autonomic crisis, etc.
  • Cons: Highly addictive, can worsen hypotension, etc.
  • Common Side Effects: difficulty sleeping, drowsiness, dizziness, clumsiness, nausea, and headaches.

 

  • Cental Nervous System Stimulants:
  • Pros: Increases vasoconstriction via alpha receptor stimulation, raise blood pressure, etc.
  • Cons: Highly addictive, normally used for ADHD, etc.
  • Common Side Effects: insomnia, loss of appetite, weight loss, stomach upset, and headaches.

 

  • Pros: ?
  • Cons: ?
  • Common Side Effects: insomnia, appetite changes, weight loss, constipation, headaches, tremors, nausea, decreased sex drive, and dizziness.

 

  • Pros: Increases vasoconstriction, increases cardiac output, increases blood pressure, stimulates respiration, stimulates epinephrine and norepinephrine production, helpful in Dysautonomia patients in very small dosages, etc.
  • Cons: Very narrow theraputic index, not well tolerated, requires frequent blood tests for levels checks, chemically similar to caffeine, risk of toxicity, etc.
  • Common Side Effects: anxiety, nausea, restlessness, diarrhea, headache, increased urination, tremors, and insomnia.

 

  • Pros: Acts centrally to decrease sympathetic nervous system tone, can stabilize heart rate and blood pressure, used in Familial Dysautonomia to counteract autonomic crisis, may be helpful in treating mast cell activation, etc.
  • Cons: Can worsen hypotension, etc.
  • Common Side Effects: headaches, constipation, decreased sex drive, and nausea.

 

  • Pros: ?
  • Cons: ?
  • Common Side Effects: dizziness, drowsiness, headaches, irritability, difficulty concentrating, confusion, clumsiness, nausea, and constipation.

 

  • Caffeine:
  • Pros: Can be used on the as-needed bases, increases vasoconstriction, increases cardiac output, increases blood pressure, increases mental alertness, etc.
  • Cons: Not well tolerated by patients with hyperadrenergenic symptoms, can cause significant dehydration, etc.
  • Common Side Effects: frequent urination, dry skin, dehydration, dizziness, irritability, nausea, and nervousness.

 

  • Pros: ?
  • Cons: ?
  • Common Side Effects: headaches, flushing, nausea, stomach pain, and diarrhea.

 

  • Pros: Increases vasoconstriction, raises blood pressure, raises red cell mass found to be low in some Dysautonomia patients, etc.
  • Cons: Life-threatening side effects, found to be somewhat less useful for symptoms of orthostatic tachycardia, requires injection, .
  • Common Side Effects: nausea, dizziness, headaches, diarrhea, fever, and pain at injection site.

 

  • Pros: Especially helpful in patients with postprandial hypotension, inhibits the release of gastrointestinal peptides, etc.
  • Cons: Requires injection, etc.
  • Common Side Effects: diarrhea, constipation, dizziness, headaches, stomach pain, nausea,  and pain at injection site.

 

  • Non-Steroidal Anti-Inflamitory Drugs {NSAID's}:
  • Pros: Somewhat benefitial to patients with postprandial hypotension, limit vasodilating effects of prostagiandins, Can be used on the as-needed bases, increase blood volume, may increase sensitivity to norepinephrine, Indocin is sometimes used for pain related to co-existing Chiari Malformation, etc.
  • Cons: Long-term use can cause serious side effects, ineffective as monotherapy, use with caution in patients with suspected NSAID allergy, etc.
  • Common Side Effects: stomach upset, diarrhea, constipation, bloating, dizziness, headaches, blurred vision, and heartburn.

 

  • IV Hydration Therapy:
  • Pros: Proven very effective in treating Dysautonomia symptoms, very few side effects, keeps the body hydrated despite vomiting, etc.
  • Cons: Usually requires frequent doctor visits, home treatment requires either a central catheter or port making patient more prone to infection, not all physicians believe benefits outway risks, time consuming, etc.
  • Common Side Effects: ?

 

  • Dietary Modifications:
  • Pros: Very few side effects, non-medicinal approach, etc.
  • Cons: Can be difficult to maintain, high-sodium diet may not be entirely healthy, dietary modifications don't work for all Dysautonomia patients, etc.
  • Common Side Effects: Frequent urination from increased fluid intake, etc.
  • Techniques: Increased Sodium, Increased Fluids, Smaller/Frequent Meals, Low Glycemic Indec, Tyramine Avoidance, etc.

 

  • Electrolyte Supplements:
  • Pros: Helpful in supplementing electrolytes lost during vomiting, extra sodium helpful in hypovolemia, etc.
  • Cons: ?
  • Common Side Effects: ?
  • Examples: Sodium {Na+}, Potassium {K+}, Chloride {Cl-}, Calcium {Ca2+}, Magnesium {Mg2+}, Bicarbonate {HCO3-}, Phosphate {PO42-}, Sulfate {SO42-}, etc.

 

  • Pros: ?
  • Cons: ?
  • Common Side Effects: drowsiness, dizziness, restlessness, blurred vision, flushing, and tachycardia.

 

 

  • Mito Cocktail:
  • Pros: Improves energy levels in patients with Dysautonomia caused by Mitochondrial Disease, can improve symptoms of gastroparesis, can improve respiratory symptoms, etc.
  • Cons: Some supplements may be difficult to swallow, doesn't help all Dysautonomia patients, etc.
  • Common Side Effects: Excess Vitamin C can cause diarrhea, Alpha Lipoic Acid can cause skin rash, etc.

 

 

  • Pros: Easy of dosing, improved nutrition, helpful in correcting vitamin deficiencies, helpful in supplementing vitamins lost during vomiting, etc.
  • Cons: ?
  • Common Side Effects: upset stomach; headache; unusual/unpleasant taste in mouth

 

  • Cooling Devices:
  • Pros: Especially useful in patients with significant heat intolerance, makes heated environments safer to Dysautonomia patients with sweating abnormalities, etc.
  • Cons: May be too cool for patients with certain temperature intolerances, etc.
  • Common Side Effects: ?

 

  • Pros: Proven very effective in treating symptoms directly related to bradycardia, etc.
  • Cons: Requires surgery, does not protect from sudden drops in blood pressure, generally considered to be a somewhat controversal treatment in Dysautonomia, etc.
  • Common Side Effects: ?

 

  • Supplemental Oxygen:
  • Pros: Very few side effects, can be used on the as-needed bases, increases mental alertness, useful during recovery of syncope, etc.
  • Cons: Difficult to obtain payment from insurnace company under a Dysautonomia diagnosis,
  • Common Side Effects: ?
  • Techniques: Oxygen Concentrator, Portable Liquid Oxygen, etc.

 

  • Compression Stockings {30-40 mmHg}:
  • Pros: Very few side effects, can be used on the as-needed bases, decreases blood pooling in the lower limbs, increases blood pressure, etc.
  • Cons: Generally considered to be uncomfortable, effectiveness fades with continued use, etc.
  • Common Side Effects: ?
  • Examples: Allegro, Jobst, Juzo, Sigvaris, etc.

 

  • Pros: ?
  • Cons: ?
  • Common Side Effects: loss of appetite, restlessness, and insomnia.

 

  • Gastrostomy Tube:
  • Pros: ?
  • Cons: ?
  • Common Side Effects: ?

 

  • Gastric Pacemakers:
  • Pros: ?
  • Cons: ?
  • Common Side Effects: ?

 

  • Chest Physiotherapy & Postural Drainage {CPT&PD}:
  • Pros: Reduces the risk of aspiration pneumonia in patients that have difficulty swallowing, etc.
  • Cons: ?
  • Common Side Effects: ?
  • Techniques: Postural Drainage and Percussion, Positive Expiratory Pressure, Chest Wall Oscillation, Active Cycle of Breathing Technique (ACBT), etc.
    • Note: Please don't be alarmed by the fact that the above links are to a cystic fibrosis website.  That website simply seemed to offer the best information on the subject as cystic fibrosis patients often use these techniques for their treatments.

 

  • Pros: Especially helpful in patients with autonomic neuropathy, etc.
  • Cons: Not well tolerated, etc.
  • Common Side Effects: insomnia, mood changes, dry skin, increased sweating, headaches, dizziness, nausea, stomach pain, and weight gain.

 

  • Pros: Helpful in treating digestive irregularities with less risk of dehydration than most laxitives, promotes drinking large amounts, can be mixed with almost any liquid, etc.
  • Cons: Can cause changes in electrolyte balance, etc.
  • Common Side Effects: nausea, bloating, and stomach upset.

 

  • Pros: Can be used on the as-needed bases, helpful in treating nausea/vomiting symptoms associated with Dysautonomia, etc.
  • Cons: Daily dosing is inconvienent, can worsen hypotension, use with caution in patients with suspected LQTS, difficult to obtain payment from insurnace company under a Dysautonomia diagnosis, etc.
  • Common Side Effects: constipation, dizziness, and drowsiness.

 

  • Pros: Helpful in treating nausea/vomiting symptoms associated with Dysautonomia, can also be used to treat co-existing allergies which are known to worsen Dysautonomia symptoms, etc.
  • Cons: Use with caution in patients sensitive to respretory depression, use with caution in hyperadrenergenic patients that may be sensitive to antihistimines, etc.
  • Common Side Effects: dizziness, drowsiness, constipation, respretory depression, headaches, and weight gain.

 

  • EGCG:
  • Pros: Increases quantities of the protein IKAP in patients with Familial Dysautonomia, fewer episodes of autonomic crisis, etc.
  • Cons: ?
  • Common Side Effects: ?

 

  • Joint Bracing:
  • Pros: Especially helpful in patients with hypermobile joints, helpful in preventing injury in co-existing Ehlers-Danlos Syndrome, etc.
  • Cons: ?
  • Common Side Effects: ?
  • Examples: ?

 

  • Pros: Occasionally used in Familial Dysautonomia to counteract autonomic crisis, etc.
  • Cons: ?
  • Common Side Effects: fatigue, dizziness, insomnia, headache, constipation, diarrhea, headahes, stomach upset, nausea, and weight gain.

 

  • Pros: Promotes relaxation allowing the body to cool, especially helpful to hyperactive patients that overheat, etc.
  • Cons: ?
  • Common Side Effects: diarrhea, dizzness, drowsiness, nausea, vomiting, and stomach upset.

 

  • Pros: Promotes relaxation allowing the body to cool, especially helpful to hyperactive patients that overheat, etc.
  • Cons: ?
  • Common Side Effects: headaches, insomnia, decreased sex drive, dizziness, drowsiness, anxiety, menstrual changes, blurred vision, and constipation.

 

  • Countermaneuvers:
  • Pros: Can be used on an as-needed basis, no cost, no concerns about drug interactions/side effects, non-invasive, may abort impending syncope (high success rate in several clinical trials in labratory setting) by increasing central blood volume and blood pressure
  • Cons: Some may be awkward in social settings, effects not long-lasting (for some patients, symptoms may return as soon as countermaneuver is ceased unless orthostatic stress is otherwise alleviated), tendency to forget to do the maneuvers in confusion/stress of oncoming syncope, the squatting countermaneuver requires muscle tensing upon standing back up again to avoid fainting at that point, some maneuvers may not be appropriate for certain patients with FD1
  • Common Side Effects: NA
  • Techniques: Clenching hands together and tensing arms repeatedly, crossing legs and tensing leg and buttox muscles repeatedly, squatting, bending forward

 

 

  • Pros: Particularly useful in patients with delayed gastric emptying, etc.
  • Cons: Long-term use can cause serious side effects, etc.
  • Common Side Effects: depression, diarrhea, insomnia, headaches, restlessness, nervousness, drowsiness, dizziness, headaches, nausea, diarrhea, and menstrual changes.

 

  • Pros: Helpful in patients exhibiting neuropathic pain as a symptom of Dysautonomia, may improve energy in concentration levels in some individuals, etc.
  • Cons: Contains a "black box" warning for increased risk suicidality,
  • Common Side Effects: drowsiness, clumsiness, constipation, stomach pain, increased appetite, insomnia, nausea, headaches, and weight gain.

 

  • Pros: Especially useful in preventing headaches including migraine headaches often associated with Dysautonomia, helpful in treating seizures,  also used to help with the pain associated with Chiari Malformation, etc.
  • Cons: Contains a "black box" warning for increased risk suicidality, unlikely to prevent seizures and/or headaches due to hypoxia, not well tolerated, etc.
  • Common Side Effects: slowed thinking, insomnia, fatigue, drowsiness, weight loss, loss of appetite, altered taste, nausea, stomach upset, speech problems, and tremors.

 

  • Pros: Especially useful in preventing headaches including migraine headaches often associated with Dysautonomia, helpful in treating seizures, etc.
  • Cons: Contains a "black box" warning for increased risk suicidality, unlikely to prevent seizures and/or headaches due to hypoxia, use with caution in patients with suspected sulfa allergy, etc.
  • Common Side Effects: slowed thinking, drowsiness, dizziness, weight loss, loss of appetite, nausea, coughing, and blurred vision.

 

  • Anti-Epileptic Drugs {AED's}:
  • Pros: Helpful in treating headaches and/or seizures common in Dysautonomia, etc.
  • Cons: Many contains a "black box" warning for increased risk suicidality, unlikely to prevent seizures and/or headaches due to hypoxia, etc.
  • Common Side Effects: blurred vision, nausea, vomiting, skin rash, dizziness, drowsiness, weight gain, weight loss, insomnia, fatigue, diarrhea, constipation, headaches, and speech difficulties.

 

  • Butcher's Broom:
  • Pros: ?
  • Cons: ?
  • Common Side Effects: ?

 

  • Hormonal Contraception:
  • Pros: Preventing hormonal changes has been helpful to some with women with worsening symptoms during menstruation, etc.
  • Cons: Stopping menstruation is somewhat controversial, etc.
  • Common Side Effects: ?

 

  • Ivabradine:
  • Pros: Reduces heart rate without vasodilation, etc.
  • Cons: ?
  • Common Side Effects: ?

 

  • Pros: ?
  • Cons: ?
  • Common Side Effects: ?

 

  • Droxidopa
  • Pros: Improves symptoms of orthostatic hypotension, especially helpful to patients with Multiple System Atrophy, etc.
  • Cons: ?
  • Common Side Effects: ?

 

  • Tilt Table Training:
  • Pros: Can be helpful in preventing symptoms associated with orthostatic intolerance, etc.
  • Cons: Time consuming, appointment based, etc.
  • Common Side Effects: ?

 

  • Sleep Medications:
  • Pros: Helpful in the Dysautonomia patients with sleep disturbances, etc.
  • Cons: Can worsen hypotension, etc.
  • Common Side Effects: dizziness, drowsiness, increased dreaming, nausea, vomiting, headaches, and fatigue.

 

 

  • Proton Pump Inhibitors {PPI's}:
  • Pros: ?
  • Cons: ?
  • Common Side Effects: diarrhea, nausea, stomach pain, and constipation.

 

  • Mast Cell Stabilizers:
  • Pros: ?
  • Cons: ?
  • Common Side Effects: headaches, stomach pain, nausea, diarrhea, constipation, fatigue, irritability, sensitivity to sunlight, stomach upset, insomnia, and bad taste.

 

  • Pros: Strengthening of the calf muscles tends to decrease blood pooling in the legs, strengthening muscles nearest to hypermobile joints can minimize dislocations in patients with Ehlers-Danlos Syndrome, improves venous tone, etc.
  • Cons: Conditioning will not decrease sense of fatigue in Dysautonomia, patients with Dysautonomia have decreased stamina, etc.
  • Common Side Effects: Blood pooling after exercise can lead to Dysautonomia symptoms including syncope.

 

  • Posterior Fossa Decompression:
  • Pros: Helpful in patients with Dysautonomia as a complication to Chiari Malformation of the brain, reduces pressure on the cerebellum and spinal cord, can improve headache symptoms, etc.
  • Cons: Requires brain surgery, the possibility of infection, won't reverse existing damage, not helpful for patients without Chiari Malformation, etc.
  • Common Side Effects: ?

 

  • Pros: Can increases mental alertness and wakefulness, etc.
  • Cons: May worsen orthostatic tachycardia, may increase palpitations, may increase resting heart rate, may worsen shortness of breath, etc. (note:  some of these side effects may lessen or resolve over time as the body adjusts to the medication)
  • Common Side Effects:  headache, dizziness, insomnia, nausea, diarrhea, dry mouth, nervousness/agitation

 

  • H1 Antihistimines:
  • Pros: Keeping allergies under control can be helpful to successful management of dysautonomia, can be used on an as-needed basis (dosing schedules vary widely by medication)
    • First-generation H1s:  some also can be useful in treating nausea/vomiting and in promoting sedation (e.g., promethazine--listed above in detail, benadryl)
    • Second-generation H1s: have less central nervous system activity and thus less side effects
  • Cons:  Although less likely with second-gen, drowsiness is possible side-effect of any antihistamine so caution is advised until you know how you respond to a particular one, particularly with activities requiring alertness (e.g., driving)
    • First-generation H1s: decrease the vasoconstrictive effect of adrenaline and noradrenaline (which may serve to further exacerbate poor vasoconstriction in dysautonomia) and antimuscarinic side-effects can include possible tachycardia
    • Second-generation H1s: two have been removed from the market due to cardiac side effects, Mizolastine/"Mizollen" (available in the UK but not the US) has cardiac contra-indications so read insert information carefully before taking
  • Common Side Effects:
    • First-gen: drowsiness, dry mouth/throat/nose, upset stomach, thickening of mucous, tachycardia, headache, difficulty urinating, tinnitis, constipation
    • Second-gen:  headache, upset stomach, diarrhea, dry mouth/throat, sore throat, blurred vision, skin rash, constipation, drowsiness

 

  • H2 Antihistmines:
  • Pros: ?
  • Cons: ?
  • Common Side Effects: ?

 


Tutaj, Marcin, Harald Marthol, Dena Berlin, Clive M.Brown, Felicia B.Axelrod, & Max J.Hilz. (2006).  Effect of Physical Countermaneuvers on Orthostatic Hypotension in Familial Dysautonomia.  Journal of Neurology, 253(1), 65-72.  Retrieved July 24, 2009 from <font>http://doc.rero.ch/lm.php?url=1000,43,2,20060912145046-MN/brown_epc.pdf</font>

2Sometimes referred to as a third-generation antihistamine.

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Start Date
May 22, 2008
by halbashes
Last Revision
Oct 13, 2009
by rubyred123