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Propranolol (Beta Blocker)

Beta blockers, including propranolol, block the receptors that are responsible for the effects of epinephrine and norepinephrine (catecholamines produced by the sympathetic nervous system). We have shown in a placebo controlled trial that propranolol decreases heart rate and acutely improves symptoms in patients with POTS. Interestingly, we found that symptoms were more improved by low dose rather than high dose propranolol.


The use of beta blockers in POTS is controversial, but we have seen many patients, including those who have previously failed  beta blocker therapy, have success with propranolol.