DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20171202

Clinicoetiological pattern and pharmacotherapy practices in patients with new onset vertigo: findings from a prospective multicenter registry in India

Mohan Kameswaran, Shripad Pujari, Jasveer Singh, Lakshya Jyoti Basumatary, Kushal Sarda, Rakesh Pore

Abstract


Background: The objective was to evaluate the clinicoetiological pattern and pharmacotherapy practices of new onset vertigo in India.

Methods: This multicentre, prospective, registry was conducted in adult patients across 37 centres. Enrolled patients were followed at week 1, month 1 and 3 to assess clinicoetiological characteristics, prescribed pharmacotherapy, safety and effectiveness of treatment.  

Results: Of the 1520 patients enrolled, 1428 (93.95%) completed the study. The mean (SD) age was 50.2 (±15.37) years and 53.2% were women. Of 202 patients reporting co-morbidities, 55.4% had cardiovascular disease and 38.6% had diabetes mellitus. Peripheral causes were predominant in majority (74.3%); benign paroxysmal positional vertigo (BPPV) being the most frequent (67.58%). Migraine affected 68.9% (80/116) patients, .as the central cause. Betahistine (74.6%) and prochlorperazine (21.75%) were the top two drugs of choice irrespective of origin, preferred by all treating specialists. Both the drugs significantly prevented recurrence by week 1 (prochlorperazine: 76.6%; betahistine: 64.2%) (p<0.001) and over 3 months. A lower daily dose of betahistine (15.6±5.26 mg) was preferred. Almost half complained of nausea and vomiting; prochlorperazine significantly reduced recurrence of both within a week (p<0.001). The treatments were well-tolerated with no reported adverse drug reactions.

Conclusions: The study demonstrates vestibular vertigo, BPPV to be the dominant type in Indian patients with new onset vertigo. Betahistine and prochlorperazine top the physicians’ preference list, with equal benefits in preventing recurrence. Prochlorperazine has an additional antinausea and antiemetic property, thereby may improve patient satisfaction. Prescription of a lower dose of betahistine calls for the need to sensitize physicians.


Keywords


Betahistine, Prochlorperazine, Registry, Vertigo, BPPV

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References


Hanley K, O’Dowd T, Considine N. A systematic review of vertigo in primary care. Br J Gen Pract. 2001;51:666-71.

Kuo CH, Pang L, Chang R. Vertigo–part 1–assessment in general practice. Aust Fam Physician. 2008;37:341-7.

Strupp M, Brandt T. Diagnosis and treatment of vertigo and dizziness. Dtsch Arztebl Int. 2008;105:173-80.

Yardley L, Putman J. Quantitative analysis of factors contributing to handicap and distress in vertiginous patients: a questionnaire study. Clin Otolaryngol Allied Sci. 1992;17:231-6.

Hannaford P, Simpson J, Bisset A, Davis A, McKerrow W, Mills R. The prevalence of ear, nose and throat problems in the community: results from a national cross sectional postal survey in Scotland. Fam Pract. 2005;22:227-33.

Neuhauser H, von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, et al. Epidemiology of vestibular vertigo: a neurotologic survey of the general population. Neurology. 2005;65:898-904.

Neuhauser HK, Radtke A, von Brevern M, Lezius F, Feldmann M, Lempert T. Burden of dizziness and vertigo in the community. Arch Intern Med. 2008;168:2118-24.

Bisdorff A, Bosser G, Gueguen R, Perrin P. The epidemiology of vertigo, dizziness, and unsteadiness and its links to co-morbidities. Front Neurol. 2013;4:29.

Skoien A, Wilhemsen K, Gjesdal S. Occupational disability caused by dizziness and vertigo: a register-based prospective study. Br J Gen Pract. 2008;58:619-23.

Olusesi AD, Abubakar J. 10 Years of vertigo clinic at national hospital Abuja, Nigeria: what have we learned? Eur Arch Otorhinolaryngol. 2016;273:3567-72.

Patangay KK, Ansari R. Benign paroxysmal positional vertigo: our experience. Indian J Otolaryngol Head Neck Surg. 2016;68:39-41.

Sloane P. Dizziness in primary care. Results from the National Ambulatory Medical Survey. J Fam Pract. 1989;29:33-8.

Yardley L, Owen N, Nazareth I, Luxon L. Prevalence and presentation of dizziness in a general practice community sample of working age people. Br J Gen Pract. 1998;48:1131-5.

Guilemany JM, Martinez P, Prades E, Sañudo I, De España R, Cuchi A. Clinical and epidemiological study of vertigo at an outpatient clinic. Acta Otolaryngol. 2004;124:49-52.

Gopinath B, McMahon CM, Rochtchina E, Mitchell P. Dizziness and vertigo in an older population: the Blue Mountains prospective cross-sectional study. Clin Otolaryngol. 2009;34:552-6.

Lacour M, Sterkers O. Histamine and betahistine in the treatment of vertigo. CNS Drugs. 2001;15:853.

Neuhauser HK. The epidemiology of dizziness and vertigo. Handb Clin Neurol. 2016;137:67-82.

Colledge NR, Barr-Hamilton RM, Lewis SJ, Wilson JA. Evaluation of investigations to diagnose the cause of dizziness in elderly people: a community based controlled study. BMJ. 1996;313:788-92.

Wada M, Takeshima T, Nakamura Y, Nagasaka S, Kamesaki T, Oki H, et al. Incidence of dizziness and vertigo in Japanese primary care clinic patients with lifestyle-related diseases: an observational study. Int J Gen Med. 2015;8:149-54.

Singh AK, Chaturvedi VN. Prochlorperazine versus cinnarizine in cases of vertigo. Indian J Otolaryngol Head Neck Surg. 1998;50:392-7.

Lai YT, Wang TC, Chuang LJ, Chen MH, Wang PC. Epidemiology of vertigo: a national survey. Otolaryngol Head Neck Surg. 2011;145:110-6.

Newman-Toker DE, Hsieh YH, Camargo CA, Pelletier AJ, Butchy GT, Edlow JA. Spectrum of dizziness visits to US emergency departments: cross-sectional analysis from a nationally representative sample. Mayo Clin Proc. 2008;83:765-75.

Agus S, Benecke H, Thum C, Strupp M. Clinical and demographic features of vertigo: findings from the REVERT registry. Front Neurol. 2013;4:48.

Berisavac II, Pavlović AM, Trajković JJ, Šternić NM, Bumbaširević LG. Drug treatment of vertigo in neurological disorders. Neurol India. 2015;63:933-9.

Swartz R, Longwell P. Treatment of vertigo. Am Fam Physician 2005;71:1115-22.

Lacour M, van de Heyning PH, Novotny M, Tighilet B. Betahistine in the treatment of Ménière’s disease. Neuropsychiatr Dis Treat. 2007;3:429-40.

Nauta JJ. Meta-analysis of clinical studies with betahistine in Ménière’s disease and vestibular vertigo. Eur Arch Otorhinolaryngol. 2014;271:887-97.

Stambolieva K, Angov G. Effect of treatment with betahistine dihydrochloride on the postural stability in patients with different duration of benign paroxysmal positional vertigo. Int Tinnitus J. 2010;16:32-6.

Naguib MB, Madian YT. Betahistine dihydrochloride with and without early vestibular rehabilitation for the management of patients with balance disorders following head trauma: a preliminary randomized clinical trial. J Chiropr Med. 2014;13:14-20.

Lacour M, Bernard-Demanze L. Interaction between vestibular compensation mechanisms and vestibular rehabilitation therapy: 10 recommendations for optimal functional recovery. Front Neurol. 2015;5:285.

Ramos AR, Ledezma Rodríguez JG, Navas Romero A, Cardenas Nuñez JL, Rodríguez Montoya V, Deschamps JJ, et al. Use of betahistine in the treatment of peripheral vertigo. Acta Otolaryngol. 2015;135:1205-11.

Whaetley D. Anthistamines and Phenothiazine compared in vertigo. The Practitioner. 1973;211:224-7.

Burt CW, Schappert SM. Ambulatory care visits to physician offices, hospital outpatient departments, and emergency departments: United States, 1999-2000. Vital Health Stat. 2004;13:1-70.

Bond CM. Comparison of buccal and oral prochlorperazine in the treatment of dizziness associated with nausea and/or vomiting. Curr Med Res Opin. 1998;14:203-12.

Ernst AA, Weiss SJ, Park S, Takakuwa KM, Diercks DB. Prochlorperazine versus promethazine for uncomplicated nausea and vomiting in the emergency department: a randomized, double-blind clinical trial. Ann Emerg Med. 2000;36:89-94.