POTS Treatment: Fluids, Compression, Exercise and Medicines Explained

By Anna Curran, RN, BSN, PHN · Last reviewed October 2026

POTS treatment usually starts with everyday measures: more fluids, extra salt if your doctor approves, compression garments and a slow, reclined exercise program. Some people also need medicine. No medicine is FDA-approved specifically for POTS, so doctors use drugs approved for other conditions, off-label, and tailor the plan to you.

There is no cure for POTS yet. But most people improve over time, and the right mix of treatments can make daily life much easier.

How POTS Treatment Works

POTS happens when your body doesn’t keep enough blood flowing back to your heart and brain when you stand. Most treatments aim to do one of three things:

Increase the amount of fluid in your blood vessels
Keep blood from pooling in your legs and belly
Calm the heart’s racing response

No single treatment works for everyone, according to NINDS. Mayo Clinic notes that medicines generally don’t work well unless fluids, salt, compression and exercise are also part of the plan. That is why the basics come first.

Fluids and Salt (as Your Doctor Advises)

Many people with POTS have low blood volume. Extra fluid and salt help the body hold onto more fluid in the blood vessels.

Fluids. The Vanderbilt Autonomic Dysfunction Center and Dysautonomia International mention 2 to 3 liters of fluid a day as a common goal. Water is the best choice. NINDS notes that drinking about 16 ounces (2 glasses) of water quickly before getting up can help raise blood pressure.

Salt. Doctors who treat POTS often recommend much more salt than the usual heart-healthy advice. Vanderbilt suggests up to 10 grams of salt a day for its patients and notes that one teaspoon of table salt is about 2 grams.

Important: Do not raise your salt intake on your own. Extra salt is not safe for everyone, especially people with high blood pressure, kidney disease or heart failure. Ask your doctor how much fluid and salt is right for you. Your doctor may suggest salty foods, electrolyte drinks or salt tablets.

Mayo Clinic points out that extra fluid alone is often not enough. The salt helps your body hold onto the fluid.

Compression Garments

Compression garments gently squeeze your legs and belly so blood doesn’t pool there when you stand.

Waist-high compression works better than knee-high socks for many people. A 2019 Cleveland Clinic Journal of Medicine review suggests waist-high stockings with 30 to 40 mmHg of compression.
Abdominal binders may be the best place to start. Vanderbilt notes that the belly holds the most pooled blood when you stand. Loosen the binder when sitting and tighten it when standing.
Compression leggings are another option that some people find easier to put on.

Compression can feel hot and snug. If it’s hard to tolerate, ask your provider or a physical therapist about other styles or a lower strength to start.

Exercise Reconditioning: Start Lying Down

Exercise is one of the most important POTS treatments, even though standing exercise can make you feel worse at first. The key is to start in a reclined position and build slowly.

Research from UT Southwestern found that a structured exercise program may help POTS more than a common heart rate medicine, according to Vanderbilt. Here is how these programs usually work:

Start reclined or seated. Recumbent bikes, rowing machines and swimming keep you from fighting gravity while you build fitness.
Add strength training, especially for the legs and core. Stronger leg muscles help push blood back to the heart.
Build up slowly. Increase time and effort a little at a time.
Move to upright exercise over time. The Cleveland Clinic Journal of Medicine review describes progressing to upright activity over about 3 months.

Be patient. The same review notes that benefits may take 4 to 6 weeks to appear, and gains are lost if you stop exercising regularly.

Ask your doctor about a referral to physical therapy or cardiac rehab. A therapist who knows POTS can set the right starting point and help you progress safely. Dysautonomia International offers a version of a reconditioning program you can bring to your provider.

Physical Counter-Maneuvers

Counter-maneuvers are simple moves that push blood out of your legs and back toward your heart. They can help when you feel symptoms coming on.

The Vanderbilt Autonomic Dysfunction Center suggests:

Cross your legs while standing and squeeze your thigh and buttock muscles.
Rise up on your toes and lower down a few times.
Keep moving, especially your leg muscles, instead of standing still.
Lie down right away if you feel faint. If you can’t lie down, sit and keep your legs moving.

Learn the early warning signs, such as lightheadedness, weakness, feeling hot or vision changes. Acting early may help prevent a faint.

Medicines Used for POTS

Medicines can help some people, especially when lifestyle measures are not enough. None of these medicines are FDA-approved specifically for POTS. A 2025 review in Frontiers in Neurology confirmed that no medicine has FDA approval for POTS, so all use is off-label. Off-label means a doctor prescribes a drug approved for another condition because evidence suggests it may help.

Your doctor will choose based on your type of POTS, your other health conditions and possible side effects.

Medicine	What it is approved for	How it may help in POTS
Fludrocortisone	Addison’s disease and sodium loss	Helps the body hold onto salt and fluid
Midodrine	Orthostatic hypotension (low blood pressure on standing)	Tightens blood vessels
Beta blockers (such as low-dose propranolol)	High blood pressure and other heart conditions	Slows the heart rate
Ivabradine	Certain types of heart failure	Slows the heart rate without lowering blood pressure

A few more details your doctor may discuss:

Fludrocortisone may cause swelling in the face, legs or ankles. Report this to your doctor.
Midodrine can cause high blood pressure when lying flat. MedlinePlus advises taking the last dose before the evening meal and at least 4 hours before bedtime, and not taking a dose before lying down.
Beta blockers often work best at low doses in POTS, according to the Cleveland Clinic Journal of Medicine review. Higher doses can be harder to tolerate.
Ivabradine was tested in a small randomized trial of 22 people with hyperadrenergic POTS. It lowered heart rate and improved some quality-of-life measures compared with placebo, as reported by the American College of Cardiology. MedlinePlus notes it should not be used in pregnancy and can cause temporary vision changes, like bright spots.

Other medicines sometimes used include pyridostigmine and clonidine. Each has its own benefits and risks.

Never start, stop or change a POTS medicine without talking with your doctor. Some of these medicines interact with each other or with drugs you take for other conditions.

Treating What’s Behind It

If your doctor finds a related condition, such as anemia, an autoimmune disease or a vitamin deficiency, treating it is part of your POTS plan too. Dysautonomia International stresses that treating any underlying cause is important.

Frequently Asked Questions

Is there an FDA-approved medicine for POTS?

No. As of late 2026, no medicine is FDA-approved specifically for POTS. Doctors prescribe medicines approved for other conditions, off-label, based on research and your symptoms.

How much salt should I eat with POTS?

That depends on your health, so ask your doctor. Some POTS specialists recommend up to about 10 grams of salt a day, but extra salt is not safe for everyone, especially people with high blood pressure, kidney or heart problems.

Why does exercise start lying down?

Reclined exercise, such as a recumbent bike or rowing, lets you build fitness without gravity pulling blood into your legs. As you get stronger, you can slowly move to upright exercise.

How long does POTS treatment take to work?

Fluids, salt and compression can help fairly quickly for some people. Exercise benefits may take 4 to 6 weeks to show. Many people need to adjust their plan over months with their doctor.

The Bottom Line

POTS treatment works best as a combination plan. Fluids, salt (only as your doctor advises), waist-high compression and a slow, reclined exercise program are the foundation. Counter-maneuvers can help when symptoms flare. Medicines like fludrocortisone, midodrine, beta blockers and ivabradine may help some people, but none are FDA-approved for POTS, so work closely with your doctor before making any changes.