Schiweck, Nicole, Langer, Katharina, Maier, Andrea et al. · Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2026 · DOI
This review examined treatments for POTS (postural orthostatic tachycardia syndrome), a condition where your heart rate jumps significantly when you stand up, causing dizziness and fatigue. POTS is common in people with ME/CFS. The researchers looked at 45 studies and found that simple first-line treatments like compression socks, physical training, extra salt, and a vagus nerve stimulation device may help, while certain medications like ivabradine and beta-blockers also showed promise in some studies.
Since POTS affects a substantial proportion of ME/CFS patients and contributes significantly to symptom burden and disability, this systematic review provides clinicians and patients with an evidence-based summary of available treatment options. For ME/CFS patients, understanding which POTS treatments have support may help guide clinical conversations and treatment planning, particularly since POTS management can improve functional capacity and quality of life.
This review does not establish which treatments are most effective for ME/CFS-specific POTS, as evidence in this population remains sparse. It does not prove that individual treatments work universally across all patients, as responses are highly variable. The review also cannot determine optimal dosing, duration, or combination therapies due to limited comparative data.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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