POTS / dysautonomia
Postural orthostatic tachycardia syndrome and the broader dysautonomia umbrella — affects ~1-3M US adults, predominantly young women (5:1), average 4-5 year diagnostic delay. Strong overlap with MCAS, EDS/hypermobility, ME/CFS, and post-COVID dysautonomia.
What changes during this transition
POTS is a sympathovagal-balance disorder defined by sustained HR rise ≥30 bpm (≥40 in adolescents) within 10 minutes of standing, without orthostatic hypotension. Subtypes matter: hyperadrenergic POTS, hypovolemic POTS, neuropathic POTS (small fiber denervation — ~30-50% of cohorts per Gibbons 2013), autoimmune POTS (anti-α/β-adrenergic + muscarinic receptor antibodies; Vernino 2021), and MCAS-POTS overlap (~30-50%; Shibao 2005). Standard-of-care leads every conversation: volume (2-3L water), sodium (8-10g daily), compression garments (20-30 mmHg waist-high), recumbent exercise, and first-line pharmacology — ivabradine has emerged as standard-of-care after Taub 2021 JACC; low-dose propranolol, midodrine, fludrocortisone, and pyridostigmine remain core. Peptides in this library are ADJUNCTS for specific overlap subsets — methylcobalamin for the small-fiber-neuropathy + confirmed-deficiency subset; KPV for the MCAS-POTS overlap subset; selank for the hyperadrenergic-anxiety overlay; oxytocin for vagal-tone modulation in the post-traumatic-onset subset. BPC-157's vasodilatory rodent findings layer mechanistically against the orthostatic-hypotension-overlap subset — substrate-only entry, not surfaced for discovery.
Important caveat
POTS is massively underdiagnosed — average 4-5 year diagnostic delay. If you have NOT had a tilt-table test or formal active stand test, that's the workup precondition. Coordinate any peptide protocol with an autonomic specialist BEFORE starting — NOT a peptide clinician. Subtype matters: autoimmune POTS antibody panel (Vernino), QSART/sudomotor testing for small fiber involvement, serum tryptase + 24h urine n-methylhistamine for MCAS overlap, and standing norepinephrine for hyperadrenergic phenotype are the diagnostic markers that matter.
Peptides editorially relevant to pots / dysautonomia
4 peptides from the library — each evidence-tiered honestly.
- SelankTier 3
Synthetic tuftsin analog (heptapeptide)
Russian-developed anxiolytic/nootropic peptide. Most clinical data is in Russian and methodologically thin by Western standards. Tier 3. Routes include intranasal — a natural pair with Juno's nasal-spray prep guide.
- B12 (Methylcobalamin)Tier 1
Vitamin (methylcobalamin)
Vitamin B12 in the methyl form. Solid evidence for treating documented deficiency and pernicious anemia. The wellness-clinic 'energy injection' market for non-deficient adults has no clinical-trial support.
- KPVTier 3
α-MSH C-terminal tripeptide
Short tripeptide fragment of a natural hormone (alpha-MSH). Appears to carry the anti-inflammatory signaling of the parent hormone without its pigmentation effects. Growing animal and early-human work, especially for inflammatory bowel disease.
- OxytocinTier 1
Posterior-pituitary neuropeptide
The labor-induction hormone (Pitocin), FDA-approved since 1962. Off-label nasal and subcutaneous use — for autism social cognition, 'bonding,' anxiolysis — has loud community framing but a messier and partly negative randomized-trial literature.
Want this list to grow? The library is editorial — if there’s a peptide you think belongs on this page with documented or mechanistically-clear evidence, send us a note with the citation and we’ll review it under the same evidence-tier discipline as every other entry.