Positives

• Roughly 71% of treatment-refractory POTS patients in a follow-up series reported sustained symptom improvement at six months on Procrit, with vasoconstrictive benefits beyond hematocrit gains ResearchGate.
  
  
• Patients with severe hypovolemic POTS who fail saline infusions, fludrocortisone, and midodrine sometimes report meaningful orthostatic tolerance gains on erythropoietin DINET.
  
  

Negatives

• Patients learn that while erythropoietin raises red cell volume, it does not actually expand plasma volume, so the postural tachycardia itself often persists PMC.
  
  
• The drug carries a black-box warning for hypertension, stroke, and serious cardiovascular events, which has scared many POTS patients off treatment USC Journal.
  
  

Hurdles & Side Effects

• POTS patients face prohibitive out-of-pocket cost for Procrit because off-label dysautonomia use is rarely covered by insurance USC Journal.
  
  
• Patients must locate a POTS-literate physician willing to prescribe and monitor injections, which is rare outside specialty autonomic centers like Vanderbilt Vanderbilt Autonomic Dysfunction Center.