flunarizine and Vertigo

Topics: Calcium Channel Blockers; Flunarizine; Humans; Migraine Disorders; Vertigo

Because maintenance antivertiginous treatment with commonly used drugs is only moderately effective, there is still need for new therapeutic concepts in the therapy of vestibular vertigo. The cerebral calcium antagonist flunarizine (Sibelium) revealed positive vestibular effects in experimental animal studies and in healthy volunteers. Clinical trials versus placebo and reference drugs proved flunarizine to be effective in the treatment of vestibular disorders. Somnolence, weight gain, and, in rare cases, extrapyramidal symptoms and depression were discussed as side effects. Further studies on flunarizine's mechanism of action are needed to elucidate whether its clinical effects are indeed due to calcium-entry blockade.

Topics: Animals; Flunarizine; Humans; Randomized Controlled Trials as Topic; Vertigo

Three primary mechanisms have been suggested as an explanation of migraine; a neuronal event, a vascular event and a mechanism focussing on the trigeminal nerve and its supply to intra- and extracranial blood vessels. None of these theories has been adequately proven yet. A neuronal point of impact, rather than a vascular one, seems to be responsible for migraine prophylaxis with calcium antagonists. Primarily vasoactive substances such as nimodipine are not or only marginally effective, whereas flunarizine with a limited vascular activity is effective. Data on other calcium antagonists are insufficient to conclude on a migraine-prophylactic activity. The only calcium antagonist that has been extensively tested for vertigo is flunarizine. In placebo-controlled trials, the drug showed to be effective in labyrinthine vertigo. The mechanism behind this effect is unclear.

Topics: Calcium; Calcium Channel Blockers; Flunarizine; Humans; Migraine Disorders; Vertigo

Flunarizine, a diphenylalkylamine, is one of the most popular antivertiginous drugs used nowadays in France. However, until now, there are very few preliminary data about the physiological or pathophysiological functions of calcium in the vestibular system. Moreover, experimental and clinical arguments are still insufficient to clearly demonstrate that 1) flunarizine is an effective antivertiginous drug and 2) this putative antivertiginous property is really due to the anticalcic action of the drug and not to a more classical antagonistic effect on H1 receptors. Much more work is needed before accepting the indication of any anticalcic drug as an effective antivertigo treatment.

Topics: Animals; Calcium Channel Blockers; Flunarizine; Humans; Vertigo; Vestibule, Labyrinth

Flunarizine is a 'selective' calcium entry blocker with a similar chemical structure and pharmacological profile to the related compound, cinnarizine. However, in contrast to cinnarizine it has a long plasma half-life and need only be given once a day. The majority of therapeutic trials in the prophylaxis of migraine, occlusive peripheral vascular disease and vertigo of central or peripheral origin have been placebo-controlled, and have shown that the drug produces significantly greater beneficial effects than placebo as evaluated by subjective and objective criteria. A small number of comparative studies have shown flunarizine to be at least as effective as pizotifen in migraine prophylaxis, and in a longer term study as effective as cinnarizine in vertigo of central origin. However, it has not been compared with other drugs which may be useful in these areas, such as methysergide in migraine prophylaxis, some antihistamines or phenothiazines in vertigo, or (understandably at this stage of its evolution) with surgical revascularisation in severe occlusive peripheral vascular disease. In preliminary placebo-controlled studies there was some evidence that flunarizine may improve impaired cognitive function in patients with cerebrovascular disorders, but such findings need further confirmation in additional carefully conducted studies. With a very long half-life, flunarizine may be given once daily; and drowsiness, the main side effect, can be minimised by taking the daily dose in the evening. Thus, it appears that flunarizine will offer a useful alternative in some therapeutic areas that can be difficult to manage with previously available therapy. However, a definitive statement on its relative place in therapy of such conditions must await a few well-controlled comparative studies.

Topics: Adult; Age Factors; Aged; Animals; Anti-Arrhythmia Agents; Anticonvulsants; Blood; Calcium Channel Blockers; Cinnarizine; Clinical Trials as Topic; Flunarizine; Histamine H1 Antagonists; Humans; Kinetics; Migraine Disorders; Piperazines; Vascular Diseases; Vasodilator Agents; Vertigo

Experience with flunarizine, a selective calcium-entry blocker, in the treatment of dizziness is reviewed. Clinical efficacy was predicted in pharmacological studies both in rabbits and humans: torsion swing or caloric induced nystagmus were significantly suppressed by flunarizine. Open therapeutic findings, using clinical and electronystagmographic or audiographic assessments as well, showed that flunarizine is of benefit to patients with vertigo of labyrinthine as well as of cerebrovascular origin. These results were confirmed in double-blind controlled trials. Flunarizine, either started with a loading dose gradually decreased thereafter, or given at a fixed 10 mg. dose schedule was proven to produce rapid improvement of dizziness and unsteadiness and to be tolerated very well.

Topics: Animals; Calcium Channel Blockers; Cerebrovascular Disorders; Cinnarizine; Clinical Trials as Topic; Double-Blind Method; Flunarizine; Humans; Labyrinth Diseases; Piperazines; Rabbits; Vertebrobasilar Insufficiency; Vertigo

Topics: Anticonvulsants; Betahistine; Flunarizine; Humans; Life Style; Migraine Disorders; Vertigo

Migrainous vertigo is a common cause of dizziness presenting to an otorhinolaryngology/otoneurology clinic. Although it causes a substantial burden to the individual and society there are no randomized controlled trails on prophylactic medication for this condition. Flunarizine, a calcium channel blocker has been used effectively in both migraine and vestibular conditions. This randomized control trial was undertaken in a tertiary academic referral center to evaluate the efficacy of flunarizine in patients with migrainous vertigo when compared to non-specific vestibular treatment of betahistine and vestibular exercises. The effect of flunarizine on two particularly disabling symptoms of vertigo and headache was studied. A total of 48 patients who were diagnosed with definitive migrainous vertigo completed the study of 12 weeks duration. Patients in arm A received 10-mg flunarizine daily along with betahistine 16 mg and paracetamol 1 gm during episodes, and arm B received only betahistine and paracetamol during episodes. Symptom scores were noted at the start of the study and at the end of 12 weeks. Analysis of the frequency of vertiginous episodes showed a significant difference between arm A and arm B (p = 0.010) and improvement in severity of vertigo between the two groups (p = 0.046). Headache frequency and severity did not improve to a significant degree in arm A as compared to arm B. The main side effects were weight gain and somnolence and this was not significantly different between the two groups. Flunarizine (10 mg) is effective in patients with migrainous vertigo who suffer from considerable vestibular symptoms.

Topics: Acetaminophen; Adolescent; Adult; Aged; Betahistine; Calcium Channel Blockers; Disorders of Excessive Somnolence; Drug Therapy, Combination; Female; Flunarizine; Histamine Agonists; Histamine Antagonists; Humans; Male; Middle Aged; Migraine Disorders; Vertigo; Weight Gain; Young Adult

The objective of the study was to evaluate the efficacy of three therapeutic strategies (Semont maneuver, flunarizine, and no treatment) in patients with benign paroxysmal positional vertigo.. Randomized prospective trial.. One hundred fifty-six consecutive patients older than 60 years of age who were affected by benign paroxysmal positional vertigo of the posterior semicircular canal were enrolled. The diagnosis was made on the basis of the history of recurrent sudden crisis of vertigo and positional-induced typical nystagmus after Dix-Hallpike positioning maneuver. Patients were randomly allocated to receive Semont liberatory maneuver (intended as a statoconia-detachment maneuver), flunarizine, or no treatment. A post-treatment negative Dix-Hallpike test result was considered as a proof of vertigo resolution.. Cure rates with Semont maneuver were significantly higher (94.2%) than those obtained with flunarizine (57.7%) and no treatment (36.4%) (P <.001). Within a 6-month follow-up, relapse rates were lower among patients treated with Semont maneuver (3.8%) than those obtained with flunarizine (5.8%) and no treatment (21.1%). All patients with resolution of symptoms and negative Dix-Hallpike test results showed a great improvement in daily activities and quality of life (P <.001).. Semont liberatory maneuver is the most successful therapy for benign paroxysmal positional vertigo and improves patients' quality of life. Diagnostic and therapeutic maneuvers are easy to perform and should be part of the medical knowledge of every general practitioner and geriatrician.

Topics: Aged; Calcium Channel Blockers; Combined Modality Therapy; Flunarizine; Follow-Up Studies; Humans; Middle Aged; Posture; Prospective Studies; Quality of Life; Vertigo

The aim of this double-blind, randomized, multicenter study was to compare the efficacy of betahistine dihydrochloride (BH) and flunarizine (FL) using the Dizziness Handicap Inventory (DHI), a validated self-assessment questionnaire that has not previously been used in a clinical trial to evaluate antivertigo drugs.. Patients with recurrent vertigo of peripheral vestibular origin and who were severely handicapped by vertigo were randomized to an 8-week course of treatment with oral BH 48 mg daily or oral FL 10 mg daily. The efficacy endpoints were the total DHI score and the physical, functional and emotional subscores.. Fifty-two patients completed the study. After 8 weeks of treatment the mean total DHI score and the physical subscore were significantly lower in the BH group compared to the FL group (7.5 and 3.6 points, respectively). The mean total DHI score as well as the three subscores decreased significantly after 4 and 8 weeks in both treatment groups.. This study showed that at 8 weeks BH is significantly more effective than FL in terms of improving the total DHI score and the physical subscore. It was also established that the DHI is a useful and reliable method for evaluating the efficacy of antivertigo drugs.

Topics: Adult; Aged; Betahistine; Double-Blind Method; Drug Administration Schedule; Female; Flunarizine; Histamine Agonists; Humans; Male; Meniere Disease; Middle Aged; Recurrence; Surveys and Questionnaires; Treatment Outcome; Vasodilator Agents; Vertigo

This prospective, open multi-centre study on flunarizine focused on the risk/benefit ratio of the use of flunarizine in the prophylaxis of migraine and in the treatment of vertigo, due to disorder of the vestibular system. The assessment of risks focused on the incidence of new events of depression and/or extrapyramidal syndrome during flunarizine treatment. For migraine, flunarizine was compared to propranolol in 686 patients; for vertigo, flunarizine was compared to betahistine in 198 patients. The incidence of depression during follow-up in this study was significantly higher in the flunarizine group than in the propranolol group in the condition of migraine. There were no observations of an extrapyramidal syndrome. There was a suggestion that flunarizine has more benefits than propranolol in the condition of migraine, and that betahistine has more benefit than flunarizine in the condition of vertigo. Differences in dosages could possible explain these differences.

Topics: Adult; Data Collection; Depressive Disorder; Female; Flunarizine; Follow-Up Studies; Humans; Male; Middle Aged; Migraine Disorders; Netherlands; Product Surveillance, Postmarketing; Prospective Studies; Vasodilator Agents; Vertigo

One hundred and seventeen adult patients suffering from vestibular vertigo were treated in a multicentre double-blind study with flunarizine (10 mg before sleeping) or betahistine dichlorhydrate (8 mg 3 times daily). The study took 2 months. The results revealed that flunarizine is significantly more active against attacks of vertigo and associated symptoms (mainly neurovegetative disorders, anxiety and headaches). The global superiority of flunarizine was confirmed by both the evaluation by the investigators and the patient. Significantly fewer patients treated with flunarizine reported side effects or interrupted the trial therapy prematurely. This study confirms the value of the calcium antagonist flunarizine in the treatment of vestibular vertigo.

Topics: Adult; Aged; Betahistine; Clinical Trials as Topic; Double-Blind Method; Female; Flunarizine; Humans; Male; Middle Aged; Multicenter Studies as Topic; Patient Dropouts; Pyridines; Vertigo

Flunarizine is a calcium antagonist which has proved clinically useful in controlling chronic vertigo. In a double blind crossover trial 10 subjects were used to compare the electronystagmic responses to motion in patients taking flunarizine, prochlorperazine maleate, or placebo. Flunarizine is shown to be a powerful peripherally acting labyrinthine suppressant, with application in the prevention of motion sickness. Flunarizine produces none of the central depressive side effects characteristic of antihistamines and anticholinergics, which are the conventional anti-motion sickness drugs.

Topics: Adult; Calcium Channel Blockers; Cinnarizine; Clinical Trials as Topic; Double-Blind Method; Electronystagmography; Flunarizine; Humans; Male; Motion Sickness; Prochlorperazine; Vertigo

The influence of different calcium entry blockers on the vestibular system was investigated. The paper reports results from animal experiments and also from clinical studies with flunarizine and nimodipine. An animal experimental model of vertebrobasilar insufficiency was developed. The effect of the two drugs on the vestibular nystagmus was studied in Alsatian dogs before and after occluding one vertebral artery. In order to analyze the influence of the drugs on the vestibular nystagmus and on the clinical symptoms in patients with vertebrobasilar insufficiency, different open and double-blind studies were performed.

Topics: Animals; Clinical Trials as Topic; Dogs; Flunarizine; Humans; Nimodipine; Nystagmus, Pathologic; Pentoxifylline; Vertebrobasilar Insufficiency; Vertigo

Flunarizine is a 'selective' calcium entry blocker with a similar chemical structure and pharmacological profile to the related compound, cinnarizine. However, in contrast to cinnarizine it has a long plasma half-life and need only be given once a day. The majority of therapeutic trials in the prophylaxis of migraine, occlusive peripheral vascular disease and vertigo of central or peripheral origin have been placebo-controlled, and have shown that the drug produces significantly greater beneficial effects than placebo as evaluated by subjective and objective criteria. A small number of comparative studies have shown flunarizine to be at least as effective as pizotifen in migraine prophylaxis, and in a longer term study as effective as cinnarizine in vertigo of central origin. However, it has not been compared with other drugs which may be useful in these areas, such as methysergide in migraine prophylaxis, some antihistamines or phenothiazines in vertigo, or (understandably at this stage of its evolution) with surgical revascularisation in severe occlusive peripheral vascular disease. In preliminary placebo-controlled studies there was some evidence that flunarizine may improve impaired cognitive function in patients with cerebrovascular disorders, but such findings need further confirmation in additional carefully conducted studies. With a very long half-life, flunarizine may be given once daily; and drowsiness, the main side effect, can be minimised by taking the daily dose in the evening. Thus, it appears that flunarizine will offer a useful alternative in some therapeutic areas that can be difficult to manage with previously available therapy. However, a definitive statement on its relative place in therapy of such conditions must await a few well-controlled comparative studies.

Topics: Adult; Age Factors; Aged; Animals; Anti-Arrhythmia Agents; Anticonvulsants; Blood; Calcium Channel Blockers; Cinnarizine; Clinical Trials as Topic; Flunarizine; Histamine H1 Antagonists; Humans; Kinetics; Migraine Disorders; Piperazines; Vascular Diseases; Vasodilator Agents; Vertigo

Vertebrobasilar insufficiency (VBI) is a clinical syndrome which includes different transient brain stem symptoms. In addition to anamnesis and clinical study electronystagmography (ENG) is regarded as the most important method for testing the labyrinthine and brain stem system. Typical findings, not only in patients with VBI, but also in animal experiments (occlusion of one vertebral artery) are an increase in nystagmus frequency and decrease in nystagmus amplitude. The present study concerns two calcium antagonists: flunarizine and nimodipine. During tests on patients the caloric and the rotatory nystagmus and during animal experiments the rotatory nystagmus was investigated. Patient tests as well as animal experiments showed, that flunarizine and nimodipine have a depressant influence on the pathologically increased nystagmus frequency. With both substances there was also a trend to normalization of nystagmus amplitude as well as an improvement of clinical symptoms.

Topics: Animals; Calcium Channel Blockers; Cerebrovascular Circulation; Cinnarizine; Clinical Trials as Topic; Dogs; Double-Blind Method; Flunarizine; Humans; Nicotinic Acids; Nimodipine; Pentoxifylline; Piperazines; Sulpiride; Vertebrobasilar Insufficiency; Vertigo

Experience with flunarizine, a selective calcium-entry blocker, in the treatment of dizziness is reviewed. Clinical efficacy was predicted in pharmacological studies both in rabbits and humans: torsion swing or caloric induced nystagmus were significantly suppressed by flunarizine. Open therapeutic findings, using clinical and electronystagmographic or audiographic assessments as well, showed that flunarizine is of benefit to patients with vertigo of labyrinthine as well as of cerebrovascular origin. These results were confirmed in double-blind controlled trials. Flunarizine, either started with a loading dose gradually decreased thereafter, or given at a fixed 10 mg. dose schedule was proven to produce rapid improvement of dizziness and unsteadiness and to be tolerated very well.

Topics: Animals; Calcium Channel Blockers; Cerebrovascular Disorders; Cinnarizine; Clinical Trials as Topic; Double-Blind Method; Flunarizine; Humans; Labyrinth Diseases; Piperazines; Rabbits; Vertebrobasilar Insufficiency; Vertigo

The anti-vertigo activity of flunarizine has been evaluated in a 16-week double-blind placebo-controlled cross-over trial involving 41 patients. After a 4-week open running-in treatment with 10 mg flunarizine daily, the 40 responders were either further treated with flunarizine--at the same dose--or given matching placebo. After another 6 weeks, they were switched to the alternative medication. Severity of vertigo, and frequency and duration of the attacks were quickly and significantly reduced with the open flunarizine dose. Continuation of the drug further produced a slight improvement whereas switching over to the placebo resulted in a significant deterioration of the patients' condition. Tinnitus seemed to be less responsive to treatment. The level of untoward effects (sedation) was low and similar for both medications.

Topics: Adult; Chronic Disease; Cinnarizine; Clinical Trials as Topic; Double-Blind Method; Drug Administration Schedule; Female; Flunarizine; Humans; Male; Middle Aged; Piperazines; Placebos; Tinnitus; Vertigo

Migraine is the third most common disease in the world with an estimated prevalence of 14.7%. The purpose of this study was to identify the characteristic changes in cervical and ocular vestibular evoked myogenic potential (VEMP) and analyse changes in symptoms and VEMP after flunarizine therapy in patients diagnosed with vestibular migraine (VM).. Prospective interventional study was conducted on 31 VM patients. Cervical VEMP (cVEMP) and ocular VEMP (oVEMP) were recorded. Flunarizine (10 mg) was given once daily for two consecutive months. Prophylactic therapy was monitored with a monthly follow-up assessment of their symptoms and VEMP was repeated after 2 months.. Headache was the chief complaint (67.7%). Vertigo was spontaneous and mostly moderate in intensity (93%). cVEMP was absent in 1 patient and oVEMP was absent in 3 patients. Post prophylactic treatment with flunarizine, there was significant reduction in the frequency (p = 0.001) and duration (p = 0.001) of headache and frequency (p = 0.001), duration (p = 0.001), and intensity (p = 0.009) of vertigo. cVEMP and oVEMP showed no significant differences (p > 0.05) between pre- and post-treatment recordings.. Treatment with flunarizine helps in considerably reducing the episodes and duration of headache, as well as episodes, duration, and intensity of vertigo.

Topics: Flunarizine; Headache; Humans; Migraine Disorders; Prospective Studies; Vertigo; Vestibular Evoked Myogenic Potentials

Topics: Anxiety; Flunarizine; Humans; Migraine Disorders; Topiramate; Vertigo

Vestibular migraine (VM) consists of recurrent episodes of vestibular symptoms that are accompanied by migraine in at least 50% of the episodes. The criteria of the Bárány Society include two diagnostic categories: "actual" vestibular migraine and probable vestibular migraine. There is a wide range of drugs that can be prescribed for the prophylactic treatment of VM, but recommendations for the selection of the most appropriate drug are currently lacking.. To measure the extent to which the prophylactic treatment of VM reduces vestibular symptoms, headache and the number of crises depending on the diagnostic category of the Bárány Society and the drug used for prophylaxis.. This is a multicenter prospective study. Patients with VM who presented to any of the participating centers and who subsequently met the VM criteria were prescribed one of the following types of prophylaxis: acetazolamide, amitriptyline, flunarizine, propranolol or topiramate. Patients were called back for a follow-up visit 5 weeks later. This allowed the intensity of vestibular symptoms, headache and the number of crises before and during treatment to be compared.. 31 Patients met the inclusion criteria. During the treatment, all the measured variables decreased significantly. In a visual analogue scale, the intensity of vestibular symptoms decreased by 45.8 points, the intensity of headache decreased by 47.8 points and patients suffered from 15.6 less monthly crises compared to the period before the treatment. No significant between-group differences were found when patients were divided based on their diagnostic category or the choice of prophylaxis prescribed to them.. The treatment of VM produces a reduction of symptoms and crises with no significant differences based on patients' diagnostic categories or the choice of prophylaxis prescribed to them.

Topics: Acetazolamide; Amitriptyline; Analgesics; Central Nervous System Agents; Flunarizine; Humans; Migraine Disorders; Propranolol; Prospective Studies; Topiramate; Vertigo; Vestibular Diseases

To assess the prevalence of vestibular migraine (VM) in patients consulting to an otolaryngology clinic, the neuro-otological associated symptoms, and the effect of prophylactic antimigrainous medication on VM symptom improvement.. Retrospective chart review.. Tertiary referral otolaryngology clinic.. We used the diagnostic criteria from the Bárány Society and the International Headache Society to allocate patients to a subgroup: VM, possible VM, and atypical VM.. The prevalence of VM, percentages of associated neurotological symptoms, and percentages of effectiveness of prophylactic medication.. Sixty-five (16%) patients were selected from the total patient population (n = 407) from which 4.2% were assigned to the definite VM group, 5.7% to the probable VM group, and 6.1% to the atypical VM group. We found a significantly different distribution between the groups for photophobia (p = 0.035), ear pressure (p = 0.023), and scotoma (p = 0.015). Thirty patients were administered with flunarizine and 68% responded with an improvement in VM symptoms (p < 0.001). For propranolol, 31 patients were treated and there was an improvement of symptoms in 73% (p < 0.001). Remarkable was the fact that these percentages were not significantly different between the subgroups.. VM is a common disorder presenting in a dizziness clinic, and detailed history taking is important to assess VM-associated symptoms and thus to prevent underdiagnosis. The latter is very important because our study shows that the majority of patients, regardless of VM subtype, can benefit from a prophylactic treatment, but further prospective studies are necessary.

Topics: Adrenergic beta-Antagonists; Adult; Calcium Channel Blockers; Dizziness; Flunarizine; Humans; Male; Middle Aged; Migraine Disorders; Otolaryngology; Photophobia; Prevalence; Propranolol; Prospective Studies; Retrospective Studies; Vertigo; Vestibule, Labyrinth

Topics: 5-Hydroxytryptophan; Adolescent; Age Factors; Antidepressive Agents; Female; Flunarizine; Humans; Male; Migraine Disorders; Time Factors; Vasodilator Agents; Vertigo

This international postmarketing observational study of flunarizine was designed to evaluate, in routine clinical practice, the risk/benefit ratio of flunarizine in its approved indications, namely prophylaxis of migraine and treatment of vertigo. Comparator drugs were propranolol in migraine and betahistine in vertigo. The study was carried out by 498 general practitioners in Belgium, The Netherlands and Germany, whose participation had been requested by mail. In total 3186 patients were entered: 1601 in the two migraine cohorts and 1585 in the two vertigo cohorts.. In the migraine study, treatment results with propranolol tended to be somewhat better than those with flunarizine, but a selection bias cannot be excluded. There was no clear difference regarding efficacy between flunarizine and betahistine in the vertigo study. The safety evaluation focused on extrapyramidal symptoms (EPS) and depression. Overall, EPS were noted in only four patients, two in the vertigo-betahistine and two in the migraine-flunarizine cohort. A total of 70 patients developed depressive symptoms (34 in the flunarizine and 24 in the propranolol migraine cohorts, but only 7 in the flunarizine and 5 in the betahistine vertigo cohorts). Patients with migraine were clearly more prone to depression than patients with vertigo, regardless of their treatment. Additional risk factors for depression were a history of depression, and, in the migraine flunarizine cohort, a high number of previous migraine treatments.

Topics: Basal Ganglia Diseases; Betahistine; Cohort Studies; Depression; Female; Flunarizine; Histamine H1 Antagonists; Humans; Male; Migraine Disorders; Product Surveillance, Postmarketing; Propranolol; Prospective Studies; Risk Factors; Vasodilator Agents; Vertigo

Ninety-eight patients with idiopathic sudden deafness were treated with a modified defibrinogenation (DF) therapy including batroxobin, low molecular dextran, vasodilators and vitamins. Hearing improvement was evaluated with two methods: categorical judgement and improvement rate (%). By categorical judgement, 60 patients (61% of the total) were classified into recovery or good improvement categories. The improvement rate was calculated for each of the 93 patients, and the average value was 64%. Modified DF therapy was effective especially for patients with severe hearing loss of 70-90 dB with flat audiogram. Although serum fibrinogen significantly decreased after batroxobin administration there was no correlation between the concentration of fibrinogen and hearing recovery. When prognostic factors were studied, the interval between the onset of hearing loss and start of treatment, initial hearing level, and the existence of vertigo all had significant correlation with the degree of hearing recovery.

Topics: Adenosine Triphosphate; Adolescent; Adult; Aged; Aged, 80 and over; Audiometry, Pure-Tone; Batroxobin; Dextrans; Female; Fibrinogen; Flunarizine; Hearing; Hearing Loss, Sudden; Humans; Male; Middle Aged; Prognosis; Time Factors; Tinnitus; Vertigo; Vitamin B 12

Ten multimorbid, geriatric, hospitalised patients, mean age 76 years, were treated for vertigo and received 10 mg flunarizine (CAS 52468-60-7; Sibelium) daily for 3 weeks. The study of the pharmacokinetics and pharmacodynamics of this dosage scheme revealed that the kinetics did not change during the three weeks of therapy. The terminal half-life is 7.3 +/- 3.3 days. Since a steady state concentration is only to be expected after about 5 half-lives, this condition was not fully met yet in most patients after three weeks. The data obtained from the patients examined are essentially identical with those in young and old healthy subjects. The unchanged kinetics during long-term treatment prevent side-effects due to cumulation on the one hand or the decrease of plasma levels to inactive concentrations resulting from enzyme induction. There was not measurable anti-aggregator effect on thrombocytes or erythrocytes. The effectiveness in connection with vertigo seems to be due to a direct labyrinth depressor activity and/or to a selective vasospecific action. No side-effects were observed during the three weeks of therapy.

Topics: Aged; Aged, 80 and over; Blood Viscosity; Female; Flunarizine; Half-Life; Hemodynamics; Humans; Male; Platelet Aggregation; Vertigo

Few calcium entry blockers have been studied in the treatment of vertigo. Flunarizine and cinnarizine are the most extensively studied substances. They have been shown to be valuable drugs in the therapeutic approach to vertigo. A few pilot studies have been performed with nimodipine but controlled data are lacking. Flunarizine has a direct long-lasting vestibulodepressant effect in both animals and humans. In patients with labyrinthine vertigo, it produced a marked symptomatic relief of symptoms significantly exceeding the effects of placebo or nicergoline. A number of studies dealing with vertigo of central etiology were also positive. Patient selection in such trials, however, is doomed to be less precise so that cautiousness must be exerted in interpreting such studies. The level of proof for flunarizine is still as good as for other substances or better. It is discussed whether the effects are due to calcium entry blocking properties.

Topics: Animals; Calcium Channel Blockers; Dogs; Flunarizine; Humans; Rabbits; Vertigo

Topics: Animals; Calcium Channel Blockers; Cinnarizine; Dogs; Flunarizine; Humans; Vertebrobasilar Insufficiency; Vertigo

The anti-vertigo activity of the flunarizine on the positional nystagmus has been evaluated in 30 subjects suffering from central or peripheral labyrinthine disorders. The medication was given only once at the dose of 10 mg and its activity was evaluated by means of electronystagmographic recording six hours after drug intake. In 9 cases the positional nystagmus, classified according to Nylèn was the first type, in 13 subjects it was the second type and 8 cases had the third type. The drug determined the inhibition of the positional nystagmus in 53% of the subjects and an evident reduction in 27% of the cases. These effects were most evident both in the central lesions and in the I and III type of the positional nystagmus. In the remaining cases (20%) the differences between the nystagmus recorded before and after treatment with flunarizine were not significant.

Topics: Adult; Aged; Cinnarizine; Flunarizine; Humans; Middle Aged; Nystagmus, Pathologic; Piperazines; Posture; Vertigo