[Drug therapy of vertigo]

O Rascol, J L Montastruc
La Revue du Praticien 1994 February 1, 44 (3): 354-60
Drug treatment of vertigo is symptomatic. Highly varied classes of drugs are used, and their mechanisms of action are poorly known. The use of these drugs is empiric as they have been insufficiently evaluated. "Emergency" treatment of acute rotatory paroxysmal vertigo includes acetyl-dl-leucine (of unknown mechanism of action), vestibuloplegic drugs (anticholinergic drugs, H1 antihistamines and calcium antagonists), and dopaminergic antagonists (for their antiemetic properties). The length of such treatment should be short so as not to compromise spontaneous vestibular compensation. In case of recurrent or chronic vertigo, in order to avoid unnecessary prescription of antivertigo drugs, the physician must first eliminate non-vestibular vertigo (such as lipothymia, hypoglycemia or phobic manifestations), benign paroxysmal positional vertigo (which requires physical therapy) and tumours (such as acoustic neurinome, requiring surgery). To treat Ménière's disease, histaminergics and calcium antagonists are used, as well as drugs that are considered to diminish the pressure of the endolymphatic liquid (diuretics, acetazolamide, hyperosmotic substances). Their superiority to placebo has not been convincingly demonstrated. Vertigo of unknown origin is no longer attributed to vascular causes and cannot justify the prescription of vasodilators of questionable efficacy. H1 antihistamines, histaminergics and calcium antagonists are still prescribed despite the general lack of proper evaluation of their efficacy. The placebo effect probably explains a good part of their therapeutic success. Because of their potential side effects, none of these drugs should be routinely prescribed on a long-term basis.

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