• Consensus recommendations suggest around 10 grams of salt per day (equivalent to 4,000 mg of sodium or about 2 heaped teaspoons). This level of intake can help expand plasma volume in people with POTS.
• Salt can be added through food, or incorporated via low-carbohydrate electrolyte drinks as part of daily management.

• Recommend the use of compression garments, particularly those offering ankle-to-waist and abdominal compression, to improve venous return and orthostatic intolerance.
• Commercially available compression garments with a compression >15-20 mmHg have been shown to be effective in reducing symptoms and slowing heart rate. Members of the Australian POTS Foundation may receive discount codes from our compression wear partners. Please see here for more information.

• Blood sugar and insulin fluctuations can worsen POTS symptoms after meals. Encouraging smaller, more frequent meals that are lower in carbohydrates is often helpful.
• If a patient is experiencing weight loss or has restrictive eating patterns due to gut symptoms, consider referral to a dietitian for additional support.

• Caution is needed in highly symptomatic patients, and recumbent movement plans should be individually tailored by a POTS-aware Physiotherapist or Exercise Physiologist. We recommend referring to our Clinician Registry for support.
• It is important that patients with marked post exertional malaise are not ‘pushed’ through high energy exercise programs.
• Movement plans should prioritise the individual’s capacity to maintain functional engagement in activities of daily living.

• Psychological therapies do not treat POTS but may support patients to adapt to lifestyle changes and manage co-morbid anxiety and mood disorders (where they exist).
• Although not highly evidenced, supportive therapies such as vagal stimulation, breathing techniques, mindfulness, and other mind-body approaches may help with patients to cope with symptoms.

• Encourage patients to avoid orthostatic triggers, especially heat exposure (e.g., hot showers).
• Suggest limiting caffeine and alcohol, as both can reduce blood volume control and increase heart rate.
• Consider addressing contributing factors such as environmental allergies, which may help ease symptoms.
• Lifestyle changes can make a difference, but many patients will still need medication alongside these strategies for meaningful symptom relief.

Carefully review and avoid medications that may worsen POTS symptoms, as adjusting or switching them can help reduce symptom burden. Examples include:

• Diuretic-containing medications such as the Yasmin oral contraceptive pill or spironolactone, which can reduce blood volume through increased fluid loss.
• SNRIs, which may aggravate tachycardia through their effects on norepinephrine.
• Stimulant medications for ADHD, which at low doses may sometimes help with fatigue and concentration in POTS, but at higher doses can increase heart rate further and may contribute to hypotension.

• Ivabradine: Lowers heart rate by slowing activity in the heart’s natural pacemaker (the sinoatrial node) without lowering blood pressure. It’s often preferred in POTS when heart rate control is needed, as it has little impact on blood pressure.
• Propranolol: A short-acting beta-blocker that reduces the effects of adrenaline, helping to lower heart rate and blood pressure. In POTS, low doses are typically used, as higher doses may overly suppress heart rate, potentially worsening symptoms such as fatigue, dizziness, or exercise intolerance.

• Fludrocortisone is often recommended in POTS management. It is a synthetic corticosteroid that helps the kidneys retain sodium and water, which increases blood volume and may improve orthostatic intolerance. However, there are no clinical trials confirming its effectiveness. Care should be taken with its side effect profile, which can include high blood pressure, low potassium, fluid retention, mood disorders, and acne.
• Desmopressin is available in Australia by prescription for approved indications, which do not include POTS. While it is mentioned in some international consensus discussions, any potential use in POTS would require specialist oversight. Close monitoring of sodium is essential due to the risk of hyponatraemia.

• Midodrine is listed by the TGA and approved for orthostatic hypotension due to autonomic dysfunction. It works by constricting blood vessels through selective alpha-1 stimulation, which raises blood pressure and can improve orthostatic symptoms. Although not specifically approved for POTS, it is often used in practice under specialist guidance.
• Phenylephrine is also an alpha-1 adrenergic agonist. By constricting blood vessels, it increases blood pressure and may help relieve orthostatic symptoms, though its role in POTS management is less well established.