Ivabradine isn’t working well enough for tachycardia/POTS. Need to supplement it. But beta blockers and calcium channel blockers are off the list. What is left to try?

The max dose of Ivabradine reduces my heart rate significantly, but it remains highly tachycardic at rest and ‘remarkable’ in POTS episodes. My cardiologist has tried adding other medications to further reduce my heart rate, but we’re running out of options. Apparently this is unusual, even among longhaulers. If you’ve been here, any advice? I’m at a loss about what questions to ask or how to take an active role in my recovery.

I’m in the UK, so limited to what can be prescribed on the NHS.

• Nonselective beta blockers (eg propranolol): can’t take them because I have asthma

• Selective beta blockers: I couldn’t tolerate the drowsiness, as even on the lowest dose I was sleeping for 20 hours a day with vivid nightmares and sleep paralysis

• Calcium channel blockers: they lower my resting heart rate but not the spikes, so it exacerbated POTS symptoms and I was constantly blacking out

Cross posted from r/covid19longhaulers