Nervenheilkunde 2022; 41(11): 789-793
DOI: 10.1055/a-1901-3560
Schwerpunkt

Wirksamkeit und pharmakologische Eignung von Cinnarizin und Dimenhydrinat zur Behandlung von Schwindel und damit verbundenen Symptomen[ * ]

Eine nicht interventionelle Praxis-StudieEfficacy and Pharmacological Appropriateness of Cinnarizine and Dimenhydrinate in the Treatment of Vertigo and Related SymptomsA non-interventional real life study
Fulvio Plescia
1   Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities Giuseppe D’Alessandro, University of Palermo, Italien
,
Pietro Salvago
2   Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata (BiND), Sezione di Audiologia, Università Degli Studi di Palermo, Italien
,
Francesco Dispenza
3   UOC Otorinolaringoiatria, A. O. U. P. Paolo Giaccone, Palermo, Italien
,
Giuseppe Messina
4   Department of Psychological, Pedagogical and Human Movement Sciences, University of Palermo, Italien
5   PosturaLab Center, Palermo, Italien
,
Emanuele Cannizzaro
1   Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities Giuseppe D’Alessandro, University of Palermo, Italien
,
Francesco Martines
2   Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata (BiND), Sezione di Audiologia, Università Degli Studi di Palermo, Italien
› Author Affiliations

ZUSAMMENFASSUNG

Ziel der vorliegenden nicht interventionellen Studie war die Untersuchung der klinischen Wirksamkeit und Verträglichkeit einer Fixkombination aus Cinnarizin (20 mg) und Dimenhydrinat (40 mg) bei Patienten, die unter Schwindel und Gleichgewichtsstörungen leiden. Zu diesem Zweck wurden 120 Erwachsene (70 Männer) mit einem Durchschnittsalter von 64 Jahren in die Studie aufgenommen. Vor Beginn der pharmakologischen Behandlung wurden alle Patienten anhand der Visual Scale of Dizziness Disorders und des Dizziness Handicap Inventory auf die Intensität des Schwindels und dessen Begleitsymptome untersucht. Im Anschluss an die anamnestische Untersuchung erhielten die Patienten 60 Tage lang 3-mal täglich die Fixkombination aus Cinnarizin und Dimenhydrinat.

Unabhängig von der Art des Schwindels führte die Fixdosiskombination 15 Tage nach Behandlungsbeginn bei mehr als 75 % aller Patienten zu einer Verringerung der mit Schwindel und Gleichgewichtsstörungen verbundenen Symptome – bei einer weiteren Verbesserung nach 60 Tagen. Interessanterweise fanden wir Unterschiede zwischen männlichen und weiblichen Patienten, was die pharmakologische Wirkung der Therapie betraf.

ABSTRACT

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 – 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 combination of cinnarizine and dimenhydrinate 3 times daily, for 60 days.

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.

1 *Die vorliegende Arbeit ist die gekürzte deutschsprachige Version der Veröffentlichung: „Efficacy and Pharmacological Appropriateness of Cinnarizine and Dimenhydrinate in the Treatment of Vertigo and Related Symptoms”. Autoren: Fulvio Plescia, Pietro Salvago, Francesco Dispenza, Giuseppe Messina, Emanuele Cannizzaro, Francesco Martines. Publiziert in: Int J Environ Res Public Health 2021; 18(9): 4787. doi.org/10.3390/ijerph18094787; Original publisher: MDPI AG, Basel, Schweiz; https://pubmed.ncbi.nlm.nih.gov/33946152/




Publication History

Article published online:
11 November 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • Literatur

  • 1 Neuhauser HK. The epidemiology of dizziness and vertigo. Handb Clin Neurol 2016; 137: 67-82
  • 2 Bronstein AM. Vision and vertigo: Some visual aspects of vestibular disorders. J Neurol 2004; 251: 381-387
  • 3 Sloan PD. Dizziness in primary care. Results from the national ambulatory medical care survey. J Fam Pract 1989; 29: 33-38
  • 4 Kerber KA, Baloh RW. The evaluation of a patient with dizziness. Neurol Clin Pract 2011; 01: 24-33
  • 5 Post RE, Dickerson LM. Dizziness: A diagnostic approach. Am Fam Physician 2010; 82: 361-369
  • 6 Smith DB.. Dizziness: The history and physical examination. In: Arenberg IK (Hrsg.) Dizziness and Balance Disorders: An Interdisciplinary Approach to Diagnosis, Treatment, and Rehabilitation. Amsterdam: Kugler Publications; 1993
  • 7 Brandt T.. Vertigo: Its Multisensory Syndromes. Berlin: Springer; 1999
  • 8 Luxon LM, Bamiou DE. Vestibular System Disorder. In: Schapira AHV (Hrsg.) Neurology and Clinical Neuroscience. Maryland Heights, MO: Mosby, Elsevier; 2006
  • 9 Hamid MA. Overview of clinical anatomy and physiology of the vestibular system. In: Arenberg IK (Hrsg.) Dizziness and Balance Disorders. Amsterdam: Kugler Publications; 1993
  • 10 Baloh RW, Honrubia V.. Clinical Neurophysiology of the Vestibular System. Oxford: University press; 2001
  • 11 Honrubia V, House M. Mechanism of posterior semicircular canal stimulation in patients with benign paroxysmal positional vertigo. Acta Otolaryngol 2001; 121: 234-240
  • 12 Cavallaro A, Martines F, Cannizzaro C. et al Role of Cannabinoids in the Treatment of Tinnitus. Acta Med Mediterr 2016; 32: 903-909
  • 13 Plescia F, Cannizzaro C, Brancato A. et al Emerging Pharmacological Treatments of Tinnitus. In: Watson J (eds) Tinnitus: Epidemiology, Causes and Emerging Therapeutic Treatments. New York: Nova Science Publishers; 2016
  • 14 Udagatti VD, Dinesh Kumar R. Migraine Related Vertigo. Indian J Otolaryngol Head Neck Surg 2017; 69: 563-567
  • 15 Oosterveld WJ. Vertigo. Current concepts in management. Drugs 1985; 30: 275-283
  • 16 Darlington CL, Smith PF. Drug treatment for vertigo and dizziness. N Z Med J 1998; 111: 332-334
  • 17 Lee C, Jones TA. Neuropharmacological Targets for Drug Action in Vestibular Sensory Pathways. J Audiol Otol 2017; 21: 125-132
  • 18 Almanza A, Navarrete F, Vega R. et al Modulation of voltage-gated Ca2+ current in vestibular hair cells by nitric oxide. J Neurophysiol 2007; 97: 1188-1195
  • 19 Oosterveld WJ.. Cinnarizine in the vertiginous syndrome. In: Towse G (ed.) Cinnarizine and the Vertiginous Syndrome. London: Academic Press Inc; 1999
  • 20 Godfraind T, Towse G, Van Nueten JM. Cinnarizine: A selective calcium entry blocker. Drugs Today 1982; 18: 27-42
  • 21 Kirtane MV, Bhandari A, Narang P. et al Cinnarizine: A Contemporary Review. Indian J Otolaryngol Head Neck Surg 2019; 71: 1060-1068
  • 22 Hausler R, Sabani E, Rohr M. L’effet de la Cinnarizine sur divers types de vertiges. Résultats cliniques et électronystagmographiques d’une étude en double aveugle. Acta Otorhinolaryngol Belg 1989; 43: 177-185
  • 23 Khilnani AK, Thaddanee R, Khilnani G. Anti vertigo Drugs – Revisited. NJIRM 2013; 04: 118-128
  • 24 Huppert D, Strupp M, Mückter H. et al Which medication do I need to manage dizzy patients?. Acta Otolaryngol 2011; 131: 228-241
  • 25 Pytel J, Nagy G, Toth A. et al Efficacy and tolerability of a fixed low-dose combination of cinnarizine and dimenhydrinate in the treatment of vertigo: A 4-week, randomized, double-blind, active- and placebo-controlled, parallel-group, outpatient study. Clin Ther 2006; 29: 84-98
  • 26 Scholtz AW, Ligner J, Loader B. et al Cinnarizine and dimenhydrinate in the treatment of vertigo in medical practice. Wien Klin Wochenschr 2016; 128: 341-347
  • 27 Farkouh A, Riedl T, Gottardi R. et al Sex-Related Differences in Pharmacokinetics and Pharmacodynamics of Frequently Prescribed Drugs: A Review of the Literature. Adv Ther 2020; 37: 644-655
  • 28 Beierle I, Meibohm B, Derendorf H. Gender differences in pharmacokinetics and pharmacodynamics. Int J Clin Pharmacol Ther 1999; 37: 529-547
  • 29 Soldin OP, Mattison DR. Sex differences in pharmacokinetics and pharmacodynamics. Clin Pharmacokinet 2009; 48: 143-157
  • 30 Ostrom NK. Women with asthma: A review of potential variables and preferred medical management. Ann Allergy Asthma Immunol 2006; 96: 655-665
  • 31 Miller AA, De Silva TM, Jackman KA. et al Effect of gender and sex hormones on vascular oxidative stress. Clin Exp Pharmacol Physiol 2007; 34: 1037-1043
  • 32 Franconi F, Carru C, Malorni W. et al The effect of sex/gender on cardiovascular pharmacology. Curr Pharm Des 2011; 17: 1095-1107
  • 33 Jochmann N, Stangl K, Garbe E. et al Female-specific aspects in the pharmacotherapy of chronic cardiovascular diseases. Eur Heart J 2005; 26: 1585-1595
  • 34 Oertelt-Prigione S, Regitz-Zagrosek V. Gender aspects in cardiovascular pharmacology. J Cardiovasc Transl Res 2009; 02: 258-266
  • 35 Kato R. Sex-related differences in drug metabolism. Drug Metab Rev 1974; 03: 1-32
  • 36 Wizemann TM, Pardue ML.. Exploring the Biological Contributions to Human Health: Does Sex Matter?. Washington: National Academies; 2001
  • 37 Narimatsu S, Kariya S, Isozaki S. et al Involvement of CYP2D6 in oxidative metabolism of cinnarizine and flunarizine in human liver microsomes. Biochem Biophys Res Commun 1993; 193: 1262-1268
  • 38 Thuerauf N, Lunkenheimer J. The impact of the CYP2D6-polymorphism on dose recommendations for current antidepressants. Eur Arch Psychiatry Clin Neurosci 2006; 256: 287-293
  • 39 Tanaka E. Gender-related differences in pharmacokinetics and their clinical significance. J Clin Pharm Ther 1999; 24: 339-346