Vasovagal syncope is a common disorder of autonomic cardiovascular regulation. Many pharmacologic agents have been proposed as effective in the management of this condition based on nonrandomized clinical trials. Notably, only 3 agents--atenolol, midodrine, and paroxetine--have demonstrated efficacy in the treatment of vasovagal syncope in at least 1 prospective, randomized, placebo-controlled clinical trial. Other therapies commonly used in treating syncope include increased salt and fluid intake and fludrocortisone. In this review, we provide a summary of currently available data that support or question the use of various pharmacologic agents for treatment of vasovagal syncope.