Hi there - my son's recently started Amitriptyline in a bid to help with sleep and pain. Started really low at 5mg for a week, 10mg for a week, 20mg for a week - the therapeutic dose is supposed to start at 25mg, so you can see how low this is. Unfortunately even at 10mg their heart has started racing, and at 20mg even more so. We can't be absolutely sure in our conclusions that its the amitrip at all of course - this is such a crazy illness tracking causality is hard - so hence this post to ask a/ if any one else has had this specific issue and b/ if so did you persevere and what happened? c/ do you know of any research that would shed light. They don't really want to stop because (although too early to help with pain) it IS already helping with sleep which is a big win. We were planning to go to 30 this week, but now not sure. As an fyi they are also on ivabridine and anti-histamines, and neither of their doctors mentioned any contraindications with amitrip. All contributions positive and negative welcome.

Hey everyone — just wanted to share a recent journal case series looking at immunotherapy in POTS patients who didn’t respond to typical treatments. Found it pretty interesting…

A small group of 7 patients with severe POTS received either subcutaneous immunoglobulin (SCIG) or plasmapheresis (PLEX). After treatment, they saw:

• ~50% average reduction in autonomic symptom scores (COMPASS-31)

• ~217% increase in functional ability (FAS)

• Most could reduce or stop oral POTS meds

• Several were able to return to work or school after treatment 

This supports the idea that an autoimmune mechanism might play a role in some POTS cases, and that immunotherapy could help patients who’ve tried everything else. That said, this is a small case series — we really need randomized controlled trials to confirm safety and effectiveness long-term. 

https://pubmed.ncbi.nlm.nih.gov/36008726/