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

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.