[Drug therapy of vertigo]

Area of Science:

• Neurology
• Pharmacology

Context:

• Vertigo treatment is symptomatic, utilizing diverse drug classes with poorly understood mechanisms.
• Current drug use for vertigo is largely empirical, with insufficient evaluation of efficacy.
• Short-term treatment is advised for acute vertigo to preserve vestibular compensation.

Purpose:

• To critically evaluate the efficacy and rationale behind current drug treatments for various vertigo types.
• To highlight the limited evidence supporting many antivertigo medications and the potential role of the placebo effect.
• To emphasize the need for proper diagnosis and consideration of non-pharmacological treatments.

Summary:

• Symptomatic drug treatments for acute vertigo include acetyl-dl-leucine, vestibuloplegic drugs, and dopaminergic antagonists.
• Recurrent or chronic vertigo requires excluding non-vestibular causes, benign paroxysmal positional vertigo, and tumors before prescribing medication.
• Treatments for Ménière's disease and vertigo of unknown origin often lack convincing evidence of superiority over placebo.

Impact:

• Underscores the need for evidence-based prescribing in vertigo management.
• Suggests caution against routine long-term prescription of antivertigo drugs due to potential side effects and limited proven benefits.
• Recommends prioritizing accurate diagnosis and exploring non-pharmacological interventions where appropriate.