What medications can cause vertigo?

Medications That Can Cause Vertigo

Several classes of medications can cause vertigo as an adverse effect, including benzodiazepines, antihistamines, antihypertensives, antidepressants, antipsychotics, anticonvulsants, and anti-inflammatory drugs. 1, 2

Common Medication Classes Associated with Vertigo

Vestibular Suppressant Medications

These medications are often used to treat vertigo but paradoxically can cause vertigo as a side effect:

• Benzodiazepines

  • Examples: diazepam, clonazepam
  • Mechanism: Potentiate inhibitory GABA effects
  • Note: While they can reduce spinning sensations, they interfere with central compensation in peripheral vestibular conditions 1

• Antihistamines

  • Examples: meclizine, diphenhydramine
  • Mechanism: Suppress the central emetic center
  • Note: Commonly used for motion sickness but can cause dizziness 1

Cardiovascular Medications

• Beta-blockers

  • Examples: atenolol
  • Mechanism: May produce vertigo, syncope, or postural hypotension, especially when combined with catecholamine-depleting drugs like reserpine 3
  • Warning: Particularly problematic when combined with calcium channel blockers 3

• Antihypertensives

  • Mechanism: Can cause postural hypotension leading to dizziness 1, 2

Other Medication Classes

• Anticonvulsants

  • Examples: Mysoline, carbamazepine, phenytoin 1, 2

• Antidepressants 2

• Antipsychotics 2

• Anti-inflammatory drugs 2

• Antibiotics 2

Risk Factors and Special Considerations

Drug Interactions Increasing Risk

1. Beta-blockers with catecholamine-depleting drugs (e.g., reserpine): Increased risk of hypotension and bradycardia leading to vertigo 3

2. Beta-blockers with calcium channel blockers: Additive effects increasing vertigo risk 3

3. Multiple medications: Polypharmacy increases fall risk, especially in elderly patients 1

High-Risk Populations

• Elderly patients: More susceptible to medication-induced vertigo and falls 1
• Patients with renal impairment: May require dose adjustments to prevent adverse effects 3
• Patients with history of vestibular disorders: May experience exacerbated symptoms 1

Clinical Approach to Medication-Induced Vertigo

Diagnostic Considerations

When evaluating vertigo, consider:

• Timing relationship between medication initiation and symptom onset
• Multiple medication use (polypharmacy)
• Distinguish between true vertigo (spinning sensation) and pseudovertigo 2

Management Recommendations

1. Identify and discontinue the offending medication when possible

2. Avoid vestibular suppressants for long-term use

   • Should not be used longer than one week to prevent inhibition of beneficial compensatory processes 4
   • Guidelines specifically recommend against routine use of vestibular suppressants for BPPV 1

3. For unavoidable medication-induced vertigo:

   • Consider dose reduction
   • Implement fall prevention strategies
   • Physical therapy for vestibular rehabilitation may be beneficial 1

Common Pitfalls and Caveats

1. Masking underlying conditions: Medication-induced vertigo may mask more serious neurological disorders 1

2. Delayed vestibular compensation: Vestibular suppressants may provide symptomatic relief but can delay central compensation mechanisms 5

3. Underreporting: Vertigo as a medication side effect is frequently underreported despite its potential to cause secondary harm through falls and injuries 2

4. Misdiagnosis: Medication-induced vertigo may be misdiagnosed as a primary vestibular disorder 1

5. Inappropriate long-term use: Vestibular suppressants should only be used short-term (less than one week) to avoid inhibiting compensatory mechanisms 4

Remember that medication-induced vertigo, while not directly life-threatening, can lead to falls, fractures, and decreased quality of life, particularly in elderly patients 2.