Orthostatic Intolerance: Causes, Symptoms, and Medication Management

When you stand up and suddenly feel lightheaded, your heart races, or your vision goes gray, you might be dealing with orthostatic intolerance, a condition where your body struggles to adjust blood flow when standing. Also known as postural orthostatic tachycardia syndrome (POTS), it’s not just feeling a little dizzy—it’s your autonomic nervous system failing to keep your blood pressure stable during posture changes. This isn’t normal aging or being out of shape. It’s a real, measurable dysfunction that affects millions, especially young women, and often gets misdiagnosed as anxiety or fatigue.

Orthostatic intolerance doesn’t happen in isolation. It’s closely tied to autonomic nervous system, the part of your nervous system that controls heart rate, blood pressure, and digestion without you thinking about it. When this system misfires, standing up triggers a spike in heart rate—sometimes over 30 beats per minute—without a matching rise in blood pressure. That’s why you feel like you’re going to pass out. It’s also linked to conditions like postural orthostatic tachycardia syndrome, a specific subtype of orthostatic intolerance defined by excessive heart rate increase upon standing, which often shows up after viral infections, pregnancy, or long periods of bed rest.

Medications play a big role in managing this condition. Some people find relief with fludrocortisone to help retain salt and fluid, or midodrine to tighten blood vessels. Others use beta-blockers to slow down their racing heart. But drugs alone rarely fix the problem—lifestyle tweaks like increasing salt intake, wearing compression socks, and doing gentle leg exercises are just as important. And if you’re on thyroid meds, antidepressants, or blood pressure drugs, some of those could be making your orthostatic intolerance worse. Timing matters. Interactions matter. What works for one person might backfire for another.

What you’ll find below are real, practical guides from people who’ve been there. From how specific drugs affect blood pressure control, to what supplements help or hurt, to how to spot when your symptoms are drug-induced—not just "normal." No fluff. No guesses. Just clear, tested advice on managing this tricky condition, one step at a time.