{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T11:37:04Z","timestamp":1789472224469,"version":"build-2803163510"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2013,9,26]]},"abstract":"<jats:sec xml:lang=\"en\"><jats:title>Background<\/jats:title><jats:p xml:lang=\"en\">Postural tachycardia syndrome (<jats:styled-content style=\"fixed-case\">POTS<\/jats:styled-content>) is a disorder of chronic orthostatic intolerance accompanied by excessive orthostatic tachycardia. Patients with<jats:styled-content style=\"fixed-case\">POTS<\/jats:styled-content>commonly have comorbid conditions such as attention deficit hyperactivity disorder, depression, or fibromyalgia that are treated with medications that inhibit the norepinephrine reuptake transporter (<jats:styled-content style=\"fixed-case\">NRI<\/jats:styled-content>).<jats:styled-content style=\"fixed-case\">NRI<\/jats:styled-content>medications can increase sympathetic nervous system tone, which may increase heart rate (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>) and worsen symptoms in<jats:styled-content style=\"fixed-case\">POTS<\/jats:styled-content>patients. We sought to determine whether<jats:styled-content style=\"fixed-case\">NRI<\/jats:styled-content>with atomoxetine increases standing tachycardia or worsens the symptom burden in<jats:styled-content style=\"fixed-case\">POTS<\/jats:styled-content>patients.<\/jats:p><\/jats:sec><jats:sec xml:lang=\"en\"><jats:title>Methods and Results<\/jats:title><jats:p xml:lang=\"en\">Patients with<jats:styled-content style=\"fixed-case\">POTS<\/jats:styled-content>(n=27) underwent an acute drug trial of atomoxetine 40\u00a0mg and placebo on separate mornings in a randomized, crossover design. Blood pressure (<jats:styled-content style=\"fixed-case\">BP<\/jats:styled-content>),<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>, and symptoms were assessed while seated and after standing prior to and hourly for 4\u00a0hours following study drug administration. Atomoxetine significantly increased standing<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>compared with placebo (121\u00b117\u00a0beats per minute versus 105\u00b115\u00a0beats per minute;<jats:italic>P<\/jats:italic>=0.001) in<jats:styled-content style=\"fixed-case\">POTS<\/jats:styled-content>patients, with a trend toward higher standing systolic<jats:styled-content style=\"fixed-case\">BP<\/jats:styled-content>(<jats:italic>P<\/jats:italic>=0.072). Symptom scores worsened with atomoxetine compared to placebo (+4.2\u00a0au versus \u22123.5\u00a0au;<jats:italic>P<\/jats:italic>=0.028) from baseline to 2 hours after study drug administration.<\/jats:p><\/jats:sec><jats:sec xml:lang=\"en\"><jats:title>Conclusion<\/jats:title><jats:p xml:lang=\"en\">Norepinephrine reuptake inhibition with atomoxetine acutely increased standing<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>and symptom burden in patients with<jats:styled-content style=\"fixed-case\">POTS<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec xml:lang=\"en\"><jats:title>Clinical Trials Registration<\/jats:title><jats:p xml:lang=\"en\"><jats:styled-content style=\"fixed-case\">URL<\/jats:styled-content>:<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/clinicaltrials.gov\">http:\/\/clinicaltrials.gov<\/jats:ext-link>. Unique identifier:<jats:styled-content style=\"fixed-case\">NCT<\/jats:styled-content>00262470.<\/jats:p><\/jats:sec>","DOI":"10.1161\/jaha.113.000395","type":"journal-article","created":{"date-parts":[[2013,9,3]],"date-time":"2013-09-03T09:53:01Z","timestamp":1378201981000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":55,"title":["Effects of Norepinephrine Reuptake Inhibition on Postural Tachycardia Syndrome"],"prefix":"10.1161","volume":"2","author":[{"given":"Elizabeth A.","family":"Green","sequence":"first","affiliation":[{"name":"Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University, Nashville, TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vidya","family":"Raj","sequence":"additional","affiliation":[{"name":"Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Psychiatry, Vanderbilt University, Nashville, TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cyndya A.","family":"Shibao","sequence":"additional","affiliation":[{"name":"Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University, Nashville, TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Italo","family":"Biaggioni","sequence":"additional","affiliation":[{"name":"Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University, Nashville, TN"},{"name":"Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Pharmacology, Vanderbilt University, Nashville, TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bonnie K.","family":"Black","sequence":"additional","affiliation":[{"name":"Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University, Nashville, TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William D.","family":"Dupont","sequence":"additional","affiliation":[{"name":"Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Biostatistics, Vanderbilt University, Nashville, TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Robertson","sequence":"additional","affiliation":[{"name":"Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University, Nashville, TN"},{"name":"Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Pharmacology, Vanderbilt University, Nashville, TN"},{"name":"Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Neurology, Vanderbilt University, Nashville, TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satish R.","family":"Raj","sequence":"additional","affiliation":[{"name":"Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University, Nashville, TN"},{"name":"Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Pharmacology, Vanderbilt University, Nashville, TN"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.43.1_Part_1.132"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9629(15)40482-3"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000267663.05398.40"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.28110"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1037\/0278-6133.22.6.643"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/MAJ.0b013e318063c6c0"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-104-3-298"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.846501"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.144501"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.2165\/11599580-000000000-00000"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcl.2010.10.009"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.761643"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/MJT.0b013e3181dd21d2"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/0091270005276737"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.2165\/00002018-200326100-00006"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2006.04.073"},{"key":"e_1_3_4_18_2","author":"Monarch Pharmaceuticals I. Florinef acetate \u2013 fludrocortisone acetate tablet product label","unstructured":"Monarch Pharmaceuticals I. Florinef acetate \u2013 fludrocortisone acetate tablet product label . Daily Med NIH Gov 2011. http:\/\/dailymed.nlm.nih.gov\/dailymed\/archives\/fdaDrugInfo.cfm?archiveid=71912 (accessed July 7, 2012).","journal-title":"Daily Med NIH Gov 2011"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.96.2.575"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.104.497594"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2012.05.002"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/0197-2456(90)90005-M"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1089\/104454603321666199"},{"key":"e_1_3_4_24_2","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/S0022-3565(25)33153-8","article-title":"A new inhibitor of norepinephrine uptake devoid of affinity for receptors in rat brain","volume":"222","author":"Wong DT","year":"1982","unstructured":"Wong DT, Threlkeld PG, Best KL, Bymaster FP. A new inhibitor of norepinephrine uptake devoid of affinity for receptors in rat brain. J Pharmacol Exp Ther. 1982;222:61\u201365.","journal-title":"J Pharmacol Exp Ther"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/0024-3205(93)90194-8"},{"key":"e_1_3_4_26_2","first-page":"R817","article-title":"Effects of desipramine on sympathetic nerve firing and norepinephrine spillover to plasma in humans","volume":"260","author":"Esler MD","year":"1991","unstructured":"Esler MD, Wallin G, Dorward PK, Eisenhofer G, Westerman R, Meredith I, Lambert G, Cox HS, Jennings G. Effects of desipramine on sympathetic nerve firing and norepinephrine spillover to plasma in humans. Am J Physiol. 1991;260:R817\u2013R823.","journal-title":"Am J Physiol"},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000036370.31856.73"},{"key":"e_1_3_4_28_2","first-page":"R824","article-title":"Central sympathoinhibition and peripheral neuronal uptake blockade after desipramine in rabbits","volume":"260","author":"Eisenhofer G","year":"1991","unstructured":"Eisenhofer G, Saigusa T, Esler MD, Cox HS, Angus JA, Dorward PK. Central sympathoinhibition and peripheral neuronal uptake blockade after desipramine in rabbits. Am J Physiol. 1991;260:R824\u2013R832.","journal-title":"Am J Physiol"},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000072786.99163.FE"},{"key":"e_1_3_4_30_2","doi-asserted-by":"publisher","DOI":"10.1185\/03007995.2013.812961"},{"key":"e_1_3_4_31_2","doi-asserted-by":"publisher","DOI":"10.1042\/CS20120276"},{"key":"e_1_3_4_32_2","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.1990.70.4.963"},{"key":"e_1_3_4_33_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200002243420803"},{"key":"e_1_3_4_34_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.107.750471"},{"key":"e_1_3_4_35_2","doi-asserted-by":"publisher","DOI":"10.1161\/ATVBAHA.111.244343"},{"key":"e_1_3_4_36_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1003114"},{"key":"e_1_3_4_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2011.02.036"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.113.000395","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,30]],"date-time":"2025-04-30T14:22:00Z","timestamp":1746022920000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.113.000395"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,9,26]]},"references-count":36,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2013,9,26]]}},"alternative-id":["10.1161\/JAHA.113.000395"],"URL":"https:\/\/doi.org\/10.1161\/jaha.113.000395","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,9,26]]},"assertion":[{"value":"2013-07-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2013-08-09","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2013-09-03","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e000395"}}