Current Perspectives in the Pharmacotherapy of Vertigo

Abstract

Vertigo is a symptom encountered very commonly in clinical practice due to a disorder in the vestibular system. In addition to dizziness it is very often accompanied by nausea and vomiting. Pharmacotherapy plays an important role in the management of vertigo. Vestibular suppressants and drugs to control nausea and vomiting constitute the mainstay of the pharmacotherapy of vertigo. Specific drug therapy can be given in patients where the underlying disease process causing the vertigo has been identified. Despite the availability of many classes of drugs, there are no definitive, universally accepted guidelines for the treatment of vertigo which makes it even more difficult to follow first-, second-and third-line therapies when treating patients. It is difficult to establish guidelines or a generally acceptable consensus in the treatment of vertigo due to the complexity of vertigo and lack of adequate randomized clinical studies.

Effect of the novel histamine H4 receptor antagonist SENS‐111 on spontaneous nystagmus in a rat model of acute unilateral vestibular loss

“…This hypothesis is supported by the interference of H 1 receptor antagonism from a co‐administered, low, and non‐sedating dose of meclizine with the SENS‐111 treatment effect: SENS‐111 has an IC 50 of ~10 μM (~2,350 ng·ml −1 ) for the H 1 receptor and ~6 μM (~1,410 ng·ml −1 ) for the H 3 receptor, concentrations exceeded in the CSF at earlier time points in the testing window. At high doses and exposures, off‐target effects of SENS‐111 on vestibular brainstem nuclei via the other histamine receptors could thus be interfering with the vertigo‐reducing benefit of peripheral suppression of vestibular imbalance (Rao Singh & Singh, 2012).…”

Effectiveness of a Vestibular Rehabilitation Protocol to Improve the Health-Related Quality of Life and Postural Balance in Patients with Vertigo

“… 11 Depending on their etiology, vestibular dysfunctions may be treated with pharmacotherapy, physiotherapy, psychotherapy, and, rarely, surgery. 12 For a long time, prescribing drugs for every person with vertiginous complaints, with no discrimination of the presented signs and symptoms, was common practice. Ganança et al stated that these monotherapeutic strategies may not be enough to solve vestibular complaints completely, in addition to predisposing the individual to the occurrence of side effects and addiction when use is prolonged.…”

Medical Treatment Approaches in Vestibular Disorders: A Descriptive Cross-Sectional Study

“…6 In addition, it should be emphasized that the treatment is not permanent unless the main diagnosis. 22 Considering all these, the importance of vestibular laboratory evaluation in the diagnosis of vertigo in order to plan the right treatment and prevent inadequate drug use becomes clear. Another dimension in the medical treatment of vertigo is the duration of the use of drugs.…”