Clinical Autonomic Research

, Volume 26, Issue 3, pp 229–233 | Cite as

Stimulant medication and postural orthostatic tachycardia syndrome: a tale of two cases

  • William P. Cheshire
Case Report


Stimulant medication may mimic the tachycardia of postural orthostatic tachycardia syndrome. Two case histories illustrate how missing the clinical distinction between a primary dysautonomia and a medication effect may have avoidable adverse consequences.


Postural orthostatic tachycardia syndrome Tachycardia Central nervous system stimulants Isoproterenol Tilt table test 


Compliance with ethical standards

Conflict of interest

The corresponding author states that there is no conflict of interest.


  1. 1.
    Freeman R, Wieling W, Axelrod FB et al (2011) Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res 21(2):69–72CrossRefPubMedGoogle Scholar
  2. 2.
    Shen W-K, Jahangir A, Beinborn D et al (1999) Utility of a single-stage isoproterenol tilt table test in adults. J Am Coll Cardiol 33(4):985–990CrossRefPubMedGoogle Scholar
  3. 3.
    Sheldon R, Killam S (1992) Methodology of isoproterenol-tilt table testing in patients with syncope. J Am Coll Cardiol 19(4):773–779CrossRefPubMedGoogle Scholar
  4. 4.
    Schroeder C, Tank J, Boschmann M et al (2002) Selective norepinephrine reuptake inhibition as a human model of orthostatic intolerance. Circulation 105:347–353CrossRefPubMedGoogle Scholar
  5. 5.
    Hammerness PG, Surman CBH, Chilton A (2011) Adult attention-deficit/hyperactivity disorder treatment and cardiovascular implications. Curr Psychiatry Rep 13:357–363CrossRefPubMedGoogle Scholar
  6. 6.
    Mick E, McManus DD, Goldberg RJ (2013) Meta-analysis of increased heart rate and blood pressure associated with CNS stimulant treatment of ADHD in adults. Eur Neuropsychopharmacol 23(6):534–541CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Westover AN, Halm EA (2012) Do prescription stimulants increase the risk of adverse cardiovascular events? A systematic review. BMC Cardiovasc Disord 12:41. doi: 10.1186/1471-2261-12-41 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Winterstein AG (2013) Cardiovascular safety of stimulants in children: findings from recent population-based cohort studies. Curr Psychiatry Rep 15(8):379. doi: 10.1007/s11920-013-0379-y CrossRefPubMedGoogle Scholar
  9. 9.
    Wolk BJ, Ganetsky M, Babu KM (2012) Toxicity of energy drinks. Curr Opin Pediatr 24:243–251CrossRefPubMedGoogle Scholar
  10. 10.
    Kpaeyeh AG, Mar PL, Raj V et al (2014) Hemodynamic profiles and tolerability of modafinil in the treatment of POTS: a randomized placebo-controlled trial. J Clin Psychopharmacol 34:738–741CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Cheshire WP (2015) Droxidopa for neurogenic orthostatic hypotension. Expert Opin Orphan Drugs 12(3):1479–1490CrossRefGoogle Scholar
  12. 12.
    Pohl R, Yeragani VK, Balon R et al (1988) Isoproterenol-induced panic attacks. Biol Psychiatry 24:891–902CrossRefPubMedGoogle Scholar
  13. 13.
    Khurana RK (2006) Experimental induction of panic-like symptoms in patients with postural tachycardia syndrome. Clin Auton Res 16(6):371–377CrossRefPubMedGoogle Scholar
  14. 14.
    Cheshire WP (2016) Ethical assessment of personal health monitoring technologies that interface with the autonomic nervous system. Ethics Med 32(1):7–13Google Scholar
  15. 15.
    Roth BL, Driscol J (2011) PDSP Ki Database. Psychoactive drug screening program (PDSP). University of North Carolina at Chapel and the United States National Institute of Mental Health. Accessed 9 Jan 2016

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Department of NeurologyMayo ClinicJacksonvilleUSA

Personalised recommendations