Drugs used in treatment of Vertigo
Vertigo is a distressing condition in which the patient feels unsteady or a spinning sensation. This feeling is often accompanied by nausea or vomiting. Many diseases can give rise to vertigo or imbalance and it is important to find out the correct cause to be able to manage the condition properly.
The ear is responsible for hearing as well maintenance of balance of the body. The most common causes of vertigo or imbalance are due to disorders related to the ear, brain and central nervous system, systemic illnesses, nutritional deficiencies, injuries or infections and certain psychiatric causes. Proper treatment of these patients is possible by identifying the underlying cause.
As the person with vertigo feels unsteady and may be scared of losing balance and falling, they often have a high level of anxiety. It is important to explain the condition along with underlying cause to allay the anxiety of the patient. This may be combined with certain medicines to control the vertigo.
Several drugs have been used to decrease the spinning sensation, control nausea and vomiting and allay the anxiety caused by vertigo. A list of some of the commonly used drugs is given below. However, it is again emphasised that treating the underlying cause of genesis of vertigo will be more beneficial to the overall recovery of the patient than suppressing the symptoms.
Most vertigo suppressing medicines are advised to be taken for short durations only during the acute attack. These medicines should be stopped after the acute episode as when they are given for prolonged spells, they interfere with recovery initiated by the central nervous system called central compensation.
Some of the commonly used drugs in treatment of vertigo include (listed alphabetically):
- Benzodiazepines – like clonazepam, diazepam, lorazepam
- Scopalamine – may be used as a skin patch SSRI – like amitryptaline
Medicines used to suppress vertigo or dizziness should be given for short duration of 3-5 days. Giving vestibular suppressants for longer duration can be detrimental to the initial recovery of the patients. A brief description of the commonly used drugs is given below.
Benzodiazepines – commonly used medicines in this group include clonazepam, diazepam and lorazepam. They act through the central nervous system by suppressing the vestibular responses. A sensory mismatch of the vestibular responses leads to the feeling of dizziness. These medicines are useful to allay the anxiety of the patient in the short term but should be stopped as soon as possible due to the risk of addiction, impaired memory and chance of jeopardizing central compensation.
Benzodiazepines should be avoided in patients with myasthenia gravis, bronchitis, chronic obstructive pulmonary disease (COPD) and sleep-apnea as they can cause depression of respiration.
Betahistine is a histamine analogue which acts as a weak H1 agonist and strong H3 receptor antagonist. It is available in 2 forms – betahistine hydrochloride and betahistine mesilate. It is used in treatment of Meniere’s disease. It is said to be useful in increasing the blood supply to the inner ear and improve compensatory process. Literature quotes betahistine to be effective in high doses. This salt should be avoided in patients with bronchial asthma and gastric ulcer in which higher concentration of histamine can aggravate the condition.
Cinnarizine is an antihistamine and calcium channel blocker which acts by reducing the irritability of the inner ear receptors helping to reduce the sensory mismatch, prevents constriction of blood vessels and improves lexibility of red blood cells to improve blood supply to end organs. It is effective in acute episodes of vertigo. It also suppresses the vomiting centre in the central nervous system. However, it should not be prescribed for long durations as it may lead to drug – induced Parkinsonism. Cinnarizine is also useful in prevention of motion sickness.
Dimenhydrinate is an antihistamine which is available over the counter. It is an effective medicine to control nausea and vomiting which may be associated along with vertigo. It is used only during acute symptoms. Drug combinations having cinnarizine with dimenhydrinate are now available to control the dizziness along with the vomiting. Dimenhydrinate may cause dryness of mouth and drowsiness. Hence patients on this medication should avoid driving. It should not be given to patients suffering from glaucoma or urinary problems.
Meclizine is a medicine belonging to the anti-histaminic group. It is effective in reducing vertigo during acute phase. It is the only anti-vertigo medicine which is safe during pregnancy and lactation. It is also useful to treat motion sickness and sea sickness. Similar to other antihistamine drugs, meclizine also can cause drowsiness and dryness of mouth.
Metaclopromide, promethazine and ondansterone are medicines given to control nausea and vomiting. Patients should avoid taking anything by mouth for at least 30 minutes after taking these medicines to be more effective.
Piracetam is a nootropic agent which is a derivative of the neurotransmitter gamma-amino butyric acid (GABA). It is said to improve the neuroplasticity and provide neuroprotective effects. It reduces the adhesion of red blood cells, prevents spasm of smaller blood vessels and improves microcirculation. It is also said to improve cognition.
The drugs described above are the more commonly used medicines in vertigo treatment. Many other drugs are also used to treat specific conditions which can be started after thorough evaluation. Steroids may be given in patients of Vestibular neuritis, labyrinthitis and auto-immune inner ear disease.
Anti-migraine prophylaxis with medicines like lunerizine, propranolol, amitryptaline , divalproex sodium or topiramate may be required. This prophylaxis has to be tailored to age, BMI, severity of symptoms, any associated disorders like hypertension, prostrate enlargement, glaucoma etc. Vestibular paroxysmia which presents with multiple short lasting episodes of spinning caused by neurovascular compression of the balance nerve is treated by carbamezepine.
Vestibular rehabilitation may be required as a co-treatment with the medicines. This rehab needs to be targeted and evolving according to the area of dysfunction within the balance system.
BPPV which is one of the commonest causes of vertigo across all age groups requires no medicinal treatment. It is caused by otoliths consisting of calcium carbonate entering the inner ear and disturbing function of the balance nerve. This is treated with liberatory procedures like Epley’s, Semont’s and Barbeque maneuvres.