Which medication do I need to manage dizzy patients?

Abstract

Vertigo and dizziness are not independent disease entities, but instead symptoms of various diseases. Accordingly, a variety of treatment approaches are required. Here we review the most relevant drugs for managing dizziness, vertigo, and nystagmus syndromes. It is important to differentiate symptomatic treatment of nausea and vomiting with, for example, dimenhydrinate and benzodiazepines, and prophylactic treatment of motion sickness with scopolamine from a causal therapy of the underlying disorders. Examples of such causal therapy include aminopyridines for downbeat nystagmus and episodic ataxia type 2; carbamazepine for vestibular paroxysmia, paroxsymal dysarthria and ataxia in multiple sclerosis, and superior oblique myokymia; betahistine, dexamethasone, and gentamicin for Menière's disease; gabapentin and memantine for different forms of acquired and congenital nystagmus; corticosteroids for acute vestibular neuritis and Cogan's syndrome; metoprolol and topiramate for vestibular migraine; and selective serotonin reuptake inhibitors such as paroxetine for phobic postural vertigo. The clinical entities are briefly described, the various medications are discussed in alphabetical order, and dosage, major side effects, contraindications, and alternative medications of each drug are displayed in boxes for easy reference.

Keywords::

• Vertigo
• dizziness
• pharmacological treatment
• vestibular neuritis
• vestibular migraine
• Ménière's disease
• vestibular paroxysmia
• episodic ataxia type 2
• phobic postural vertigo
• downbeat nystagmus

Acknowledgments

The authors thank Judy Benson for critically reading and copy editing the manuscript. The work was supported by the German BMBF (German Ministry of Education and Research) and the Hertie Foundation.

Declaration of interest: Dr Brandt serves as Co-Editor in Chief of the Journal of Neurology and receives royalties from the publication of Vertigo and Dizziness: Common Complaints (Springer, 2010). Dr Strupp serves as Assistant Editor of the Journal of Neurology and Editor-in-Chief of Frontiers in Neuro-otology; has received speaker honoraria from Solvay Pharmaceuticals, Inc./Abbott and GlaxoSmithKline; and receives royalties from the publication of Vertigo and Dizziness: Common Complaints (Springer, 2010).