Published: 2 March 2017
Prescriber Update 38(1): 12-13
Vertigo is a sensation of motion either of the body or the surrounding environment. It occurs when the brain receives conflicting visual, proprioceptive and vestibular information about one’s position in space3.
Vertigo is often described by patients as ‘dizziness’, a non-specific term used to express a variety of sensations that may also include light-headedness, faintness and imbalance, all of which have many possible causes. It is important to distinguish between these symptoms as the cause and management may differ.
A variety of medicines have been associated with vertigo (Table 1).
Some medicines that cause vertigo are also ototoxic (eg, aminoglycosides, anti-inflammatory medicines, phosphodiesterase type-5 inhibitors, furosemide). When a patient who is taking a medicine known to be ototoxic presents with vertigo, dose reduction or discontinuation of the medicine may need to be considered to prevent irreversible hearing loss.
Table 1. Examples of medicines that may cause vertigo (this is not an exhaustive list)
|Antibiotics||aminoglycosides, macrolides, minocycline, nitrofurantoin, sulfamethoxazole|
|Anticonvulsants||levetiracetam, phenytoin, pregabalin|
|Anti-inflammatories||celecoxib, parecoxib, naproxen, prednisone|
|Antimalarials||mefloquine, quinine, hydroxychloroquine|
|Cardiovascular drugs||nifedipine, furosemide, indapamide, prazosin, terazosin, glyceryl trinitrate, isosorbide mononitrate, sotalol, timolol|
|Gastroenterology drugs||omeprazole, lansoprazole, sucralfate|
|Rheumatology drugs||zolendronic acid, alendronate|
|Phosphodiesterase type-5 inhibitors||sildenafil, vardenafil|
|Other medicines||lithium, haloperidol, benzodiazepines, desmopressin, melatonin|
The Centre for Adverse Reactions Monitoring (CARM) received 98 case reports of vertigo from 1 January 2006 to 31 December 2015.
The most frequently reported medicine was influenza trivalent vaccine (11 reports). However, only three of the reports gave a clear description of vertigo. In one of these cases, vertigo was associated with severe headache and weakness on one side. In the remaining eight cases, the term vertigo has been used, but it is not clear from the case description whether it was true vertigo or dizziness.
The second most frequently reported medicine was thyroxine (eight reports). The majority of these cases appear to be related to a change in formulation that was introduced in September 2007.
The next most frequently reported medicines are simvastatin (five reports), venlafaxine (five) and omeprazole (four).
As is often the case for medicines with an established safety profile, cases of vertigo associated with medicines that are well known to cause vertigo (eg, aminoglycosides), are rarely reported to CARM.
Vertigo is not listed as an adverse effect in the data sheets of the majority of medicines in the cases reported to CARM. However, it is worth noting, ‘dizziness’ is listed as an adverse effect.
When reporting cases of ‘vertigo’ to CARM, it is helpful to differentiate between true vertigo and other forms of ‘dizziness’. A description of the patient’s symptoms is useful, particularly whether or not the patient experienced a sense of motion (eg, ‘felt that the room was spinning’). This helps CARM and Medsafe to identify whether any update to the medicine’s data sheet is necessary and any further communication is required.