Hemodynamic profiles and tolerability of modafinil in the treatment of postural tachycardia syndrome a randomized, placebo-controlled trial

John Kpaeyeh, Philip L. Mar, Vidya Raj, Bonnie K. Black, Amy Arnold, Italo Biaggioni, Cyndya A. Shibao, Sachin Y. Paranjape, William D. Dupont, David Robertson, Satish R. Raj

Research output: Contribution to journalArticle

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Abstract

Background: Postural tachycardia syndrome (POTS) is characterized clinically not only by an exaggerated increase in heart rate (HR), but an associated cognitive impairment that disables many patients. Modafinil might be effective in improving the cognitive symptoms, but modafinil may stimulate the sympathetic nervous system and worsen tachycardia in POTS. We tested the hypothesis that modafinil would worsen tachycardia and orthostatic symptoms in POTS. Methods: Patients with POTS (n = 54) underwent a randomized crossover trial with modafinil 100 mg versus placebo. Heart rate and systolic blood pressure (SBP) were measured seated and standing before modafinil or placebo administration and then hourly for 4 hours. Results: Over 4 hours, standing HR was not significantly different between the modafinil and placebo groups (analysis of variance [ANOVA] Pdrug = 0.328), but seated SBP was significantly higher in the modafinil group (mean [SD], 109 [12] mm Hg vs 104 [10] mm Hg; P = 0.004). Modafinil also significantly increased both the seated SBP (ANOVA Pdrug = 0.004) and the standing SBP (ANOVA Pdrug = 0.041) over time. There was no significant difference between modafinil and placebo over the 4-hour period with regard to POTS symptom burden scores (14 [12] vs 14 [12]; P = 0.962). Conclusions: Modafinil did not significantly worsen standing HR or acute orthostatic symptoms in patients with POTS compared with the placebo group and improved upright blood pressure. Therefore, modafinil could be tested as a potential treatment for the cognitive impairment in POTS.

Original languageEnglish (US)
Pages (from-to)738-741
Number of pages4
JournalJournal of Clinical Psychopharmacology
Volume34
Issue number6
DOIs
StatePublished - Dec 1 2014

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Postural Orthostatic Tachycardia Syndrome
Randomized Controlled Trials
Hemodynamics
Placebos
Blood Pressure
Heart Rate
Therapeutics
Analysis of Variance
Tachycardia
modafinil
Neurobehavioral Manifestations
Sympathetic Nervous System
Cross-Over Studies

All Science Journal Classification (ASJC) codes

  • Psychiatry and Mental health
  • Pharmacology (medical)

Cite this

Kpaeyeh, John ; Mar, Philip L. ; Raj, Vidya ; Black, Bonnie K. ; Arnold, Amy ; Biaggioni, Italo ; Shibao, Cyndya A. ; Paranjape, Sachin Y. ; Dupont, William D. ; Robertson, David ; Raj, Satish R. / Hemodynamic profiles and tolerability of modafinil in the treatment of postural tachycardia syndrome a randomized, placebo-controlled trial. In: Journal of Clinical Psychopharmacology. 2014 ; Vol. 34, No. 6. pp. 738-741.
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abstract = "Background: Postural tachycardia syndrome (POTS) is characterized clinically not only by an exaggerated increase in heart rate (HR), but an associated cognitive impairment that disables many patients. Modafinil might be effective in improving the cognitive symptoms, but modafinil may stimulate the sympathetic nervous system and worsen tachycardia in POTS. We tested the hypothesis that modafinil would worsen tachycardia and orthostatic symptoms in POTS. Methods: Patients with POTS (n = 54) underwent a randomized crossover trial with modafinil 100 mg versus placebo. Heart rate and systolic blood pressure (SBP) were measured seated and standing before modafinil or placebo administration and then hourly for 4 hours. Results: Over 4 hours, standing HR was not significantly different between the modafinil and placebo groups (analysis of variance [ANOVA] Pdrug = 0.328), but seated SBP was significantly higher in the modafinil group (mean [SD], 109 [12] mm Hg vs 104 [10] mm Hg; P = 0.004). Modafinil also significantly increased both the seated SBP (ANOVA Pdrug = 0.004) and the standing SBP (ANOVA Pdrug = 0.041) over time. There was no significant difference between modafinil and placebo over the 4-hour period with regard to POTS symptom burden scores (14 [12] vs 14 [12]; P = 0.962). Conclusions: Modafinil did not significantly worsen standing HR or acute orthostatic symptoms in patients with POTS compared with the placebo group and improved upright blood pressure. Therefore, modafinil could be tested as a potential treatment for the cognitive impairment in POTS.",
author = "John Kpaeyeh and Mar, {Philip L.} and Vidya Raj and Black, {Bonnie K.} and Amy Arnold and Italo Biaggioni and Shibao, {Cyndya A.} and Paranjape, {Sachin Y.} and Dupont, {William D.} and David Robertson and Raj, {Satish R.}",
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Kpaeyeh, J, Mar, PL, Raj, V, Black, BK, Arnold, A, Biaggioni, I, Shibao, CA, Paranjape, SY, Dupont, WD, Robertson, D & Raj, SR 2014, 'Hemodynamic profiles and tolerability of modafinil in the treatment of postural tachycardia syndrome a randomized, placebo-controlled trial', Journal of Clinical Psychopharmacology, vol. 34, no. 6, pp. 738-741. https://doi.org/10.1097/JCP.0000000000000221

Hemodynamic profiles and tolerability of modafinil in the treatment of postural tachycardia syndrome a randomized, placebo-controlled trial. / Kpaeyeh, John; Mar, Philip L.; Raj, Vidya; Black, Bonnie K.; Arnold, Amy; Biaggioni, Italo; Shibao, Cyndya A.; Paranjape, Sachin Y.; Dupont, William D.; Robertson, David; Raj, Satish R.

In: Journal of Clinical Psychopharmacology, Vol. 34, No. 6, 01.12.2014, p. 738-741.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Hemodynamic profiles and tolerability of modafinil in the treatment of postural tachycardia syndrome a randomized, placebo-controlled trial

AU - Kpaeyeh, John

AU - Mar, Philip L.

AU - Raj, Vidya

AU - Black, Bonnie K.

AU - Arnold, Amy

AU - Biaggioni, Italo

AU - Shibao, Cyndya A.

AU - Paranjape, Sachin Y.

AU - Dupont, William D.

AU - Robertson, David

AU - Raj, Satish R.

PY - 2014/12/1

Y1 - 2014/12/1

N2 - Background: Postural tachycardia syndrome (POTS) is characterized clinically not only by an exaggerated increase in heart rate (HR), but an associated cognitive impairment that disables many patients. Modafinil might be effective in improving the cognitive symptoms, but modafinil may stimulate the sympathetic nervous system and worsen tachycardia in POTS. We tested the hypothesis that modafinil would worsen tachycardia and orthostatic symptoms in POTS. Methods: Patients with POTS (n = 54) underwent a randomized crossover trial with modafinil 100 mg versus placebo. Heart rate and systolic blood pressure (SBP) were measured seated and standing before modafinil or placebo administration and then hourly for 4 hours. Results: Over 4 hours, standing HR was not significantly different between the modafinil and placebo groups (analysis of variance [ANOVA] Pdrug = 0.328), but seated SBP was significantly higher in the modafinil group (mean [SD], 109 [12] mm Hg vs 104 [10] mm Hg; P = 0.004). Modafinil also significantly increased both the seated SBP (ANOVA Pdrug = 0.004) and the standing SBP (ANOVA Pdrug = 0.041) over time. There was no significant difference between modafinil and placebo over the 4-hour period with regard to POTS symptom burden scores (14 [12] vs 14 [12]; P = 0.962). Conclusions: Modafinil did not significantly worsen standing HR or acute orthostatic symptoms in patients with POTS compared with the placebo group and improved upright blood pressure. Therefore, modafinil could be tested as a potential treatment for the cognitive impairment in POTS.

AB - Background: Postural tachycardia syndrome (POTS) is characterized clinically not only by an exaggerated increase in heart rate (HR), but an associated cognitive impairment that disables many patients. Modafinil might be effective in improving the cognitive symptoms, but modafinil may stimulate the sympathetic nervous system and worsen tachycardia in POTS. We tested the hypothesis that modafinil would worsen tachycardia and orthostatic symptoms in POTS. Methods: Patients with POTS (n = 54) underwent a randomized crossover trial with modafinil 100 mg versus placebo. Heart rate and systolic blood pressure (SBP) were measured seated and standing before modafinil or placebo administration and then hourly for 4 hours. Results: Over 4 hours, standing HR was not significantly different between the modafinil and placebo groups (analysis of variance [ANOVA] Pdrug = 0.328), but seated SBP was significantly higher in the modafinil group (mean [SD], 109 [12] mm Hg vs 104 [10] mm Hg; P = 0.004). Modafinil also significantly increased both the seated SBP (ANOVA Pdrug = 0.004) and the standing SBP (ANOVA Pdrug = 0.041) over time. There was no significant difference between modafinil and placebo over the 4-hour period with regard to POTS symptom burden scores (14 [12] vs 14 [12]; P = 0.962). Conclusions: Modafinil did not significantly worsen standing HR or acute orthostatic symptoms in patients with POTS compared with the placebo group and improved upright blood pressure. Therefore, modafinil could be tested as a potential treatment for the cognitive impairment in POTS.

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DO - 10.1097/JCP.0000000000000221

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