Positives

• A hyperadrenergic POTS patient reported that a low dose of methyldopa let them walk without dangerous BP and HR spikes and sleep through the night for the first time in years POTS Support.
  
  
• Patients tolerate methyldopa better than clonidine because its longer half-life avoids the sharp peaks and troughs that cause rebound symptoms Autonomic Neuroscience.
  
  

Negatives

• Many patients on methyldopa develop worsening fatigue, drowsiness, and mental clouding that can compound POTS-related brain fog Health Rising.
  
  
• Aldomet reviewers describe dry mouth, dizziness, and depressive mood changes that limit long-term tolerability Drugs.com.
  
  

Hurdles & Side Effects

• Patients without confirmed hyperadrenergic POTS often get worse on methyldopa, so a trial doubles as a high-stakes diagnostic test requiring close supervision POTS Support.
  
  
• Few cardiologists are familiar with using methyldopa for POTS, and patients often must travel to autonomic specialty centers for the prescription Vanderbilt Autonomic Dysfunction Center.