Pharmacology of balance and dizziness

Abstract

Dizziness and vertigo encompass a spectrum of balance-related symptoms caused by a variety of etiologies. Balance is affected by many systems: proprioceptive pathways, and visual, cerebellar, vestibulocochlear, and vascular/vasovagal systems. Treatment includes antihistamines, antiemetics, benzodiazepines, anti-inflammatory, anti-Meniere's, anti-migraine, antidepressants, anticonvulsants, and aminopyridines. Many medications may cause these balance-related symptoms. Onset characteristics differ and may be reversible or irreversible. Ototoxic drugs may affect the cochlea, the vestibular system, or both. Medications, whether at "therapeutic" or toxic doses, have a spectrum of side effects, depending on the medication and individual. The section on drugs that treat dizziness and balance deficiencies was divided to elaborate on medications by classes and etiology specific treatment. Drugs with potential to cause balance-related symptoms were chosen to elaborate on specific medical issues encountered in rehabilitation. Background on advantages of certain drugs and methods to minimize adverse effects are reviewed. Effective treatment depends on generating an accurate diagnosis, using the appropriate drug, appropriate dosage, and for an appropriate duration. For every medication, there is a spectrum of side effects at "therapeutic" and toxic doses, depending on the medication and individual. Practitioners must ensure correct diagnoses and cater their treatments to the patients' clinical scenario and medical units' capacities.