Efficacy and Pharmacological Appropriateness of Cinnarizine and Dimenhydrinate in the Treatment of Vertigo and Related Symptoms

Abstract

Vertigo is not itself a disease, but rather a symptom of various syndromes and disorders that jeopardize balance function, which is essential for daily activities. It is an abnormal sensation of motion that usually occurs in the absence of motion, or when a motion is sensed inaccurately. Due to the complexity of the etiopathogenesis of vertigo, many pharmacological treatments have been tested for efficacy on vertigo. Among these drugs, cinnarizine, usually given together with dimenhydrinate, appears to be the first-line pharmacotherapy for the management of vertigo and inner ear disorders. Based on these considerations, the present non-interventional study aimed to investigate the clinical efficacy and tolerability of a fixed combination of cinnarizine (20 mg) and dimenhydrinate (40 mg) in patients suffering from vertigo-related symptoms. To this end, we enrolled 120 adults-70 males, and 50 females-with an average age of 64 years. Before beginning pharmacological treatment, all patients were screened for the intensity of vertigo, dizziness, and concomitant symptoms through the Visual Scale of Dizziness Disorders and Dizziness Handicap Inventory scales. At the end of the anamnestic evaluation, patients received the fixed-dose combination of cinnarizine (20 mg) plus dimenhydrinate (40 mg) 3 times daily, for 60 days. The results of this study provide further insight regarding the efficacy of the fixed combination when used to reduce symptoms of vestibular vertigo of central and/or peripheral origin, after both the 15- and 60-day therapies. Independent of the type of vertigo, the fixed combination was able to reduce dizziness- and vertigo-associated symptoms in more than 75% of all patients treated, starting from 15 days of therapy, and improving 60 days after starting the therapy. Interestingly, we also found differences between male and female patients in the framework of the pharmacological effects of therapy. This study provides further details concerning the therapeutic efficacy of the fixed combination of cinnarizine and dimenhydrinate, and also focuses attention on the possibility that these drugs could act in a gender-specific manner, paving the way for further research.

Keywords: cinnarizine; dimenhydrinate; dizziness; pharmacological treatment of vertigo; vertigo.

Figure 1

Timeline of the experimental procedures. M: male; F: female; T0: time at which the pharmacological treatment started; T15: 15 days after the beginning of the pharmacological treatment; T60: end of the treatment.

Figure 2

Reduction of dizziness symptoms, evaluated using the Dizziness Handicap Inventory (DHI), assessed at different times after pharmacological treatment with a fixed-combination preparation of cinnarizine (20 mg) plus dimenhydrinate (40 mg). Data refer to n = 120 patients, and are represented as the mean ± SD of DHI symptoms. *** p < 0.001 vs. T15; °°° p < 0.001 vs. T0. T0: baseline; T15: evaluation after 15 days from the start of therapy; T60: evaluation at the end of therapy.

Figure 3

Reduction of dizziness symptoms, evaluated using the Dizziness Handicap Inventory (DHI), assessed at different times after pharmacological treatment with a fixed-combination preparation of cinnarizine (20 mg) plus dimenhydrinate (40 mg). Data refer to (A) n = 70 male, and (B) n = 50 female patients, and are represented as the mean ± SD of DHI symptoms. *** p < 0.001 vs. T15; °°° p < 0.001 vs. T0. T0: baseline; T15: evaluation after 15 days from the start of therapy; T60: evaluation at the end of therapy.

Figure 4

The intensity of vertigo and concomitant symptoms, as evaluated by the five-point verbal rating (or visual analogue) scale—ranging from no vertigo (0) to rarely (1), occasionally (2), frequently (3), and continuously (4)—has been taken into account in order to assess the efficacy of treatment with a fixed-combination preparation of cinnarizine (20 mg) plus dimenhydrinate (40 mg) on the reduction of the triggering factors of the dizziness itself. Data refer to n = 120 patients, and are represented as the mean ± SD of the factors able to trigger vertigo. *** p < 0.001 vs. T15; °°° p < 0.001 vs. T0. T0: baseline; T15: evaluation after 15 days from the start of therapy; T60: evaluation at the end of therapy.

Figure 5

The intensity of vertigo and concomitant symptoms as evaluated by the five-point verbal rating (or visual analogue) scale—ranging from no vertigo (0) to rarely (1), occasionally (2), frequently (3), and continuously (4)—have been taken into account in order to assess the efficacy of treatment with a fixed-combination preparation of cinnarizine (20 mg) plus dimenhydrinate (40 mg) on the reduction of the triggering factors of the dizziness itself. Data refer to n = 70 male patients, and are represented as the mean ± SD of the factors able to trigger vertigo. * p < 0.05, ** p < 0.01, *** p < 0.001 vs. T15; °°° p < 0.001 vs. T0. T0: baseline; T15: evaluation after 15 days from the start of therapy; T60: evaluation at the end of therapy.

Figure 6

The intensity of vertigo and concomitant symptoms as evaluated by the five-point verbal rating (or visual analogue) scale—ranging from no vertigo (0) to rarely (1), occasionally (2), frequently (3), and continuously (4)—have been taken into account in order to assess the efficacy of treatment with a fixed-combination preparation of cinnarizine (20 mg) plus dimenhydrinate (40 mg) on the reduction of the triggering factors of the dizziness itself. Data refer to n = 50 female patients, and are represented as the mean ± SD of the factors able to trigger vertigo. * p < 0.05 vs. T15; °° p < 0.001, °°° p < 0.001 vs. T0. T0: baseline; T15: evaluation after 15 days from the start of therapy; T60: evaluation at the end of therapy.