Anti vertigo Drugs-Revisited
Anti vertigo Drugs
DOI:
https://doi.org/10.70284/njirm.v4i4.574Keywords:
Anticholinergic drugs for vertigo, Antihistaminics as antivertigo drugs, Pharmacotherapy of vertigoAbstract
Vertigo is a sense of whirling and rotation and is frequently associated with nausea and vomiting. Vertigo is a cardinal manifestation of vestibular disorders. Pharmacotherapy is required for symptomatic treatment of vertigo and motion sickness irrespective of the aetiology. Drugs like cinnarizine, betahistine and scopolamine are time honoured drugs. Antihistaminics and phenothiazines are also useful agents. Surprisingly, very few newer agents have shown undisputed efficacy against vertigo. This review describes the neurotransmitters involved in the genesis of vertigo and current status and evolution of appropriate pharmacological options for the treatment. [Khilnani AK et al NJIRM 2013; 4(4) : 118-128]
References
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3. Takeda N, Mashahiro M, Hasegawa S, Kubo T, Matsunaga T. Neurochemical mechanisms of motion sickness. Am J Otolaryngol 10: 351-359, 1989
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5. Pedigo NW Jr, Brizzee KR. Muscarinic cholinergic receptors in area postrema and brain stem areas regulating emesis. Brain Res Bull 1985;14:169-77
6. Nerveen JV, Pompeiano O, Collewign H. Depression of the vestibule-ocular reflex and optokinetic responses in intrafloccular microinjection of GABA-A and GABA-B agonists in rabbit. Arch Ital Biol 1989; 127:243-63.
7. Cohen B, de jong J. Meclizine and placebo in treating vertigo of vestibular origin. Relative efficacy a double blind study. Arch Neurol 1972; 27:129-35.
8. Johnston AR, Him A, Dutia MB. CA. Differential regulation of GABA-A and GABA-B receptors during vestibular compensation. Neuroreport. 2001; 12:597-600.
9. Sasa M, takeshita S, Amano T, Kurishu K. Primary neurotransmitters and regulatory substances onto vestibular nucleus neurons. Biol Sci Space. 2001 Dec;15(4):371-4.
10. Cheung BS, Money KE, Kohl RL, Kinter LB. Investigation of antimotion sickness drugs in the squirrel monkey. J Clin Pharmacol 1992; 32:163-75.)
11. Norfleet WT, Degioanni JJ, calkins DS. Treatment of motion sickness in parabolic flight with buccal scopolamine. Aviat Space Environ Med 1992; 63:46-51
12. Klocker N, Hanschke W, Toussaint S, Verse T. Scopolamine nasal spray in motion sickness: a randomised, controlled, and crossover study for the comparison of two scopolamine nasal sprays with oral dimenhydrinate and placebo. European journal of Pharmaceutical sciences. 2001; 13:227-32.
13. Parrott AC. Transdermal scolpolamine: A review of its effects upon motion sickness, psychological performance and physiological functioning. Aviat Space Envirn Med 1989; 60:01-09
14. Pingree BJ, Pethybridge RJ. A comparison of the efficacy of cinnarizine with scopolamine in the treatment of seasickness. Aviation space and environmental medicine. 1994; 65:597-605.
15. Gordon CR, Gonen A, Nachum Z, Doweck I, Spitzer O, Shupak A. The effects of dimenhydrinate, cinnarizine and transdermalscopolamine on performance. Journal of Psychopharmacology. 2001; 15:167-72.
16. Osterholm RK, Camoriano JK. Transdermal scoplomanie psychosis. JAMA 1982;247:3081
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18. Gordon CR, Shupak A, Doweck I, spitzer O. Allergic contact dermatitis. Caused by transdermal hyosine BMJ 1989; 298:1220-21.
19. JF Golding, JR Stott. Comparison of the effects of a selective muscarinic receptor antagonist and hyoscine (scopolamine) on motion sickness, skin conductance and heart rate. Bri J Clin Pharmacol 1997 Jun; 43 (6): 633-7.
20. Timmerman H. Pharmacotherapy of Vertigo: Any news to be expected? Acta Otolaryngol (Stockh) 1994; 513(Suppl):28-32
21. Jackson RT, Turner JS Jr. Astamizole:its use in the treatment of patients with chronic vertigo. Arch otolaryngol Head Neck surg 1987; 113:898-902.
22. Lackner JR, Graybiel A. use of promethazine to hasten adaptation to provocative motion. J clin Pharmacol 1994; 34:644-48.
23. Wood CD, Cramer DB, Graybiel A. Antimotion sickness drug efficacy. Otolaryngol Head Neck Surg 1981; 89:1041-44.
24. Muth Er, Jokerst M, Stern RM, Koch KL. Effects of dimenhydrinate on gastric tacharrhythmia and symptoms of vection induced motion sickness. Aviat Space envirn Med 1995; 66:1041-45.
25. Wood CD, Graybiel A. Evaluation of sixteen antimotion sickness drugs under controlled laboratory conditions. Aerospace Med 1968; 39:1341-44.
26. Weinstein SE, Stern RM. Comparison of Marezine and Dramamine in preventing symptoms of motion sickness. Aviation space and environmental medicine. 1997; 68: 890-4.
27. Tighilet B, Leonard J, Lacour M. Betahistine dihydrochloride treatment facilitates vestibular compensation in the cat. Journal of vestibular research. 1995; 5:53-66.
28. Mira E, Guidetti G, Ghikardi PL, Fattori B, Malnnino N, Maiolono L et al. Betahistine dihydrochloride in the treatment of peripheral
vestibular vertigo. European archives of Oto-Rhino-Laryngology. 2003; 260:73-7.
29. Halmagyi GM. Vertigo and vestibular disorders. In Eadie JM. Eds Drug Therapy in Neurology,Churchill Livingstone, Edinburgh, 1992, p383.
30. Kingma H, Bonink M, Meulenbroeks A. Dose dependent effect of Betahistine on the vestibulo-ocular reflex:a double blind placebo controlled study in patients with paroxysmal vertigo. Acta Otolaryngologica 1997;117(5):641-6
31. Smith WK, Sankar V, Pfleiderer AG. A national survey amongst UK otolaryngologists regarding the treatment of Meniere’s disease. Laryngol Otol 2005; 119:102-105.
32. Della Pepa C, Guidetti G, Eandi M. Betahistine in the treatment of vertiginous syndromes: a meta-analysis. Acta otorhinolaryngol Ital 2006 Aug; 26: 208-15.
33. Johnson WH, Fenton RS, Evans A. Effects of droperidol in the management of vestibular disorders. Laryngoscope 1976; 86:946-54.
34. Miller JD, Brizzee KR. The antiemetic ptoperties of l-sulpiride in a ground based model of space motion sickness. Life Scienc 1987;41:1815-22.
35. Irving C, Richman PB, Kalafas C. Droperidol for the treatment of acute peripheral vertigo. Am J Emerg Med 1999;17:109-110.
36. Wood CD, Cramer DB, Graybiel A. Antimotion sickness drug efficacy. Otolaryngol Head Neck Surg 1981;89:1041-44.
37. Lee JA, Watson LA, Boothby G. calcium antagonists in the prevention of motion sickness. Aviat Space Envirn Med 1990;61:1022-25.
38. Pianese CP, Hidalgo LO, Gonzalez RH, Madrid CE, Ponce JE, Ramirez AM et al. New approaches to the management of peripheral vertigo: Efficacy and safety of two calcium antagonists in a 12 week, multinational, double blind study. Otology and Neurotology. 2002; 23: 357-63.
39. Shupak A, Doweck I, Gordon CR, Spitzer O. Cinnarizine in the prophylaxis of sea sickness. Clin Pharmacol Therap 1994; 55:670-80.
40. Casucci G, Costanzo A, Riva R et al. Central actions of Cinnarizine and Flunarizine. Asaccadic eye movement study. Clin Neuropharmacol 1994;17:417-22
41. Schmidt R, Oestreich W. Flunarizine in the treatment of vestibular vertigo. Experimental and clinical data. J cardiovasc Pharmacol 1991;18 (Suppl 8 ):S 27-30
42. Lassen LF, Hiesh BE, Kamerer DB. Use of nimodipine in the medical treatment of Miniere’s disease. Clinical Experience. Am J Otol 1996;17:577-80
43. Stern RM, Uijtdehaage SH, Muth ER, Koch Kl. Effects of Phenytoin on vection induced motion sickness and gastric myoelectric activity. Aviat Space Environ Med 1994; 65:518-21
44. Stahl JS, Rottach KG, Averbuch-Heller L, Maydell RD et al. A pilot study of gabapentin as treatment for acquired nystagmus. Neuro-Ophthalmology 1996;16:107-113
45. Sekitani T, McCabe BF, Ryu JH. Drug effects on the medial vestibular nucleus. Arch Otolaryngol 1971; 93:581-89.
46. McClure JA, Lycett P, Baskerville JC. Diazepam as an antimotion sickness drug. J Otolaryngol 1982;11:253-59
47. Marill KA, Walsh MJ. Nelson BK. Intravenous lorazepam versus dimenhydrinate for treatment of vertigo in the emergency department A randomized clinical trial. Ann Emerg Med 2000;36:310-19
48. Kohl RL, calkins DS. Mandell AJ. Arousal and stability: The effects of five new sympathomimetic drugs suggest a new principle for the prevention of space motion sickness. Aviat Space Envirn Med 1986; 57:137-43.
49. Kohl RH, Sandoz GR, raschke MF et al. Facilitation of adaptation and acute tolerance to stressful sensory input by doxepin and scolpolamine plus amphetamine. J Clin Pharmacol 1993;33:1092-1103
50. Dagilas A; Kimiskidis V; Aggelopoulou M; Kapaki E; Fitili C; Libitaki G; Papagiannopoulos S; Kazis D; Kazis A; Aidonis A. Changes in blood neurotransmitter and Steroid levels during evoked vertigo. Otology and Neurotology: May 2005- Volume 26- Issue 3 pp 476-480.
51. Parnes LS, Sun Ah, Freeman DJ. Corticosteroids pharmacokinetics in the inner ear fluids: an
animal study followed by clinical application. Laryngoscope. 1999; 109: 1-17.
52. Shea Jr JJ. The role of dexamethasone or streptomycin perfusion tn the treatment of Meniere’s disease. Otolaryngologic Clinics of North America. 1997; 30: 1051-9.
53. Morales-Luckie E, Cornejo-Saurez A, Zaragoza-Contreras MA, Gonzalez-Perez O. Oral administration of prednisone to control refractory vertigo in Ménière's disease: a pilot study. Otol Neurotol 2005 Sept;26(5):1022-6.
54. Ariyasu L, Byl FM, Sprague MS, Adour KK. The beneficial effect of methylprednisolone in acute vestibular vertigo. Arch otolaryngol Head Neck Surg.1990 Jun;116(6):700-3.
55. Toshiaki Yamanaka, Masashi Sasa, Taku Amano, Hiroshi Miyahara and Takashi Matsunaga. Role of glucocorticoid in vestibular compensation in relation to activation of Vestibular Nucleus Neurons. Acta Oto-laryngologica 1995, Volume 115, No. s519, Pages 168-72.
56. Seemungal, Barry M.; Gresty, Michael A.; Bronstein, Adolfo M. The endocrine system, vertigo and balance. Current opinion in neurology; February 2001- Volume 14- Issue 1- PP 27-34.
57. Satyanarayana R. Pondugula, Joel D. Sanneman, Philine Wangemann, Pierre G. Milhaud and Daniel C. Marcus. AJP- Renal Physiol June 1, 2004 vol. 286 no. 6F1127-F1135.
58. Van Deelen GW, Huizing EH. Use of a diuretic (dyazide) in the treatment of Meniere’s disease. A double-blind cross-over placebo- controlled study. ORL; Journal of Otolaryngology and its related Specialities. 1986; 48: 287-92.
59. Salley Jr LH, Grimm M, Sismanis A, Spencer RF, Wise CM. Methotrexate in the management of immune mediated cochleovestibular disorders: clinical experience with 53 patients. Journal of Rheumatology. 2001; 28:1037-40.
60. Rascol O, Hain TC, Brefel C, Benazet M, Clanet M, Montastruc J. Antivertigo medication and drug induced vertigo-A pharmacological review. DRUGS 1995; 50 :777-791.
61. Kluysken P, Lambert P, D’Hooge D. Trimetazidine versus betahistine in vestibular vertigo: A double blind study. Ann OtolaryngolChir cervicofac 1990; 107 (Suppl-1): 20-27(French).
62. Drew S, Davies E. Effectiveness of Ginkgo biloba in treating tinnitis. Double blind placebo controlled trial. BMJ 2001; 322:73.
63. Hain TC. Alternative treatments for Miniere’s Disease. http://www.dizziness-and-
balance.com/disorders/miniere’s/men alt.html-9th January,2008.
2. Goldberg JM,Brichta AM, Wackym PA. Efferent vestibular system: Anatomy, physiology and neurochemistry. In: Beitz JA, Andersen JH (eds). Neurochemistry of the vestibular system. London: CRC Press, 2000: 61-94.
3. Takeda N, Mashahiro M, Hasegawa S, Kubo T, Matsunaga T. Neurochemical mechanisms of motion sickness. Am J Otolaryngol 10: 351-359, 1989
4. Vibert N, Serafin M, De Waele C, Babalian A, Muhlethaler M, Vidal PP. Modulatory effects of monoamines on central vestibular neurons: possible functional implications. In: Beitz JA, Andersen JH (eds). Neurochemistry of the vestibular system. London: CRC Press, 2000: 163-81.
5. Pedigo NW Jr, Brizzee KR. Muscarinic cholinergic receptors in area postrema and brain stem areas regulating emesis. Brain Res Bull 1985;14:169-77
6. Nerveen JV, Pompeiano O, Collewign H. Depression of the vestibule-ocular reflex and optokinetic responses in intrafloccular microinjection of GABA-A and GABA-B agonists in rabbit. Arch Ital Biol 1989; 127:243-63.
7. Cohen B, de jong J. Meclizine and placebo in treating vertigo of vestibular origin. Relative efficacy a double blind study. Arch Neurol 1972; 27:129-35.
8. Johnston AR, Him A, Dutia MB. CA. Differential regulation of GABA-A and GABA-B receptors during vestibular compensation. Neuroreport. 2001; 12:597-600.
9. Sasa M, takeshita S, Amano T, Kurishu K. Primary neurotransmitters and regulatory substances onto vestibular nucleus neurons. Biol Sci Space. 2001 Dec;15(4):371-4.
10. Cheung BS, Money KE, Kohl RL, Kinter LB. Investigation of antimotion sickness drugs in the squirrel monkey. J Clin Pharmacol 1992; 32:163-75.)
11. Norfleet WT, Degioanni JJ, calkins DS. Treatment of motion sickness in parabolic flight with buccal scopolamine. Aviat Space Environ Med 1992; 63:46-51
12. Klocker N, Hanschke W, Toussaint S, Verse T. Scopolamine nasal spray in motion sickness: a randomised, controlled, and crossover study for the comparison of two scopolamine nasal sprays with oral dimenhydrinate and placebo. European journal of Pharmaceutical sciences. 2001; 13:227-32.
13. Parrott AC. Transdermal scolpolamine: A review of its effects upon motion sickness, psychological performance and physiological functioning. Aviat Space Envirn Med 1989; 60:01-09
14. Pingree BJ, Pethybridge RJ. A comparison of the efficacy of cinnarizine with scopolamine in the treatment of seasickness. Aviation space and environmental medicine. 1994; 65:597-605.
15. Gordon CR, Gonen A, Nachum Z, Doweck I, Spitzer O, Shupak A. The effects of dimenhydrinate, cinnarizine and transdermalscopolamine on performance. Journal of Psychopharmacology. 2001; 15:167-72.
16. Osterholm RK, Camoriano JK. Transdermal scoplomanie psychosis. JAMA 1982;247:3081
17. Luetje CM, Wooten J. Clinical manifestations of transdermal scopolamine addiction. Ear Nose Throat J 1996; 75:210-14.
18. Gordon CR, Shupak A, Doweck I, spitzer O. Allergic contact dermatitis. Caused by transdermal hyosine BMJ 1989; 298:1220-21.
19. JF Golding, JR Stott. Comparison of the effects of a selective muscarinic receptor antagonist and hyoscine (scopolamine) on motion sickness, skin conductance and heart rate. Bri J Clin Pharmacol 1997 Jun; 43 (6): 633-7.
20. Timmerman H. Pharmacotherapy of Vertigo: Any news to be expected? Acta Otolaryngol (Stockh) 1994; 513(Suppl):28-32
21. Jackson RT, Turner JS Jr. Astamizole:its use in the treatment of patients with chronic vertigo. Arch otolaryngol Head Neck surg 1987; 113:898-902.
22. Lackner JR, Graybiel A. use of promethazine to hasten adaptation to provocative motion. J clin Pharmacol 1994; 34:644-48.
23. Wood CD, Cramer DB, Graybiel A. Antimotion sickness drug efficacy. Otolaryngol Head Neck Surg 1981; 89:1041-44.
24. Muth Er, Jokerst M, Stern RM, Koch KL. Effects of dimenhydrinate on gastric tacharrhythmia and symptoms of vection induced motion sickness. Aviat Space envirn Med 1995; 66:1041-45.
25. Wood CD, Graybiel A. Evaluation of sixteen antimotion sickness drugs under controlled laboratory conditions. Aerospace Med 1968; 39:1341-44.
26. Weinstein SE, Stern RM. Comparison of Marezine and Dramamine in preventing symptoms of motion sickness. Aviation space and environmental medicine. 1997; 68: 890-4.
27. Tighilet B, Leonard J, Lacour M. Betahistine dihydrochloride treatment facilitates vestibular compensation in the cat. Journal of vestibular research. 1995; 5:53-66.
28. Mira E, Guidetti G, Ghikardi PL, Fattori B, Malnnino N, Maiolono L et al. Betahistine dihydrochloride in the treatment of peripheral
vestibular vertigo. European archives of Oto-Rhino-Laryngology. 2003; 260:73-7.
29. Halmagyi GM. Vertigo and vestibular disorders. In Eadie JM. Eds Drug Therapy in Neurology,Churchill Livingstone, Edinburgh, 1992, p383.
30. Kingma H, Bonink M, Meulenbroeks A. Dose dependent effect of Betahistine on the vestibulo-ocular reflex:a double blind placebo controlled study in patients with paroxysmal vertigo. Acta Otolaryngologica 1997;117(5):641-6
31. Smith WK, Sankar V, Pfleiderer AG. A national survey amongst UK otolaryngologists regarding the treatment of Meniere’s disease. Laryngol Otol 2005; 119:102-105.
32. Della Pepa C, Guidetti G, Eandi M. Betahistine in the treatment of vertiginous syndromes: a meta-analysis. Acta otorhinolaryngol Ital 2006 Aug; 26: 208-15.
33. Johnson WH, Fenton RS, Evans A. Effects of droperidol in the management of vestibular disorders. Laryngoscope 1976; 86:946-54.
34. Miller JD, Brizzee KR. The antiemetic ptoperties of l-sulpiride in a ground based model of space motion sickness. Life Scienc 1987;41:1815-22.
35. Irving C, Richman PB, Kalafas C. Droperidol for the treatment of acute peripheral vertigo. Am J Emerg Med 1999;17:109-110.
36. Wood CD, Cramer DB, Graybiel A. Antimotion sickness drug efficacy. Otolaryngol Head Neck Surg 1981;89:1041-44.
37. Lee JA, Watson LA, Boothby G. calcium antagonists in the prevention of motion sickness. Aviat Space Envirn Med 1990;61:1022-25.
38. Pianese CP, Hidalgo LO, Gonzalez RH, Madrid CE, Ponce JE, Ramirez AM et al. New approaches to the management of peripheral vertigo: Efficacy and safety of two calcium antagonists in a 12 week, multinational, double blind study. Otology and Neurotology. 2002; 23: 357-63.
39. Shupak A, Doweck I, Gordon CR, Spitzer O. Cinnarizine in the prophylaxis of sea sickness. Clin Pharmacol Therap 1994; 55:670-80.
40. Casucci G, Costanzo A, Riva R et al. Central actions of Cinnarizine and Flunarizine. Asaccadic eye movement study. Clin Neuropharmacol 1994;17:417-22
41. Schmidt R, Oestreich W. Flunarizine in the treatment of vestibular vertigo. Experimental and clinical data. J cardiovasc Pharmacol 1991;18 (Suppl 8 ):S 27-30
42. Lassen LF, Hiesh BE, Kamerer DB. Use of nimodipine in the medical treatment of Miniere’s disease. Clinical Experience. Am J Otol 1996;17:577-80
43. Stern RM, Uijtdehaage SH, Muth ER, Koch Kl. Effects of Phenytoin on vection induced motion sickness and gastric myoelectric activity. Aviat Space Environ Med 1994; 65:518-21
44. Stahl JS, Rottach KG, Averbuch-Heller L, Maydell RD et al. A pilot study of gabapentin as treatment for acquired nystagmus. Neuro-Ophthalmology 1996;16:107-113
45. Sekitani T, McCabe BF, Ryu JH. Drug effects on the medial vestibular nucleus. Arch Otolaryngol 1971; 93:581-89.
46. McClure JA, Lycett P, Baskerville JC. Diazepam as an antimotion sickness drug. J Otolaryngol 1982;11:253-59
47. Marill KA, Walsh MJ. Nelson BK. Intravenous lorazepam versus dimenhydrinate for treatment of vertigo in the emergency department A randomized clinical trial. Ann Emerg Med 2000;36:310-19
48. Kohl RL, calkins DS. Mandell AJ. Arousal and stability: The effects of five new sympathomimetic drugs suggest a new principle for the prevention of space motion sickness. Aviat Space Envirn Med 1986; 57:137-43.
49. Kohl RH, Sandoz GR, raschke MF et al. Facilitation of adaptation and acute tolerance to stressful sensory input by doxepin and scolpolamine plus amphetamine. J Clin Pharmacol 1993;33:1092-1103
50. Dagilas A; Kimiskidis V; Aggelopoulou M; Kapaki E; Fitili C; Libitaki G; Papagiannopoulos S; Kazis D; Kazis A; Aidonis A. Changes in blood neurotransmitter and Steroid levels during evoked vertigo. Otology and Neurotology: May 2005- Volume 26- Issue 3 pp 476-480.
51. Parnes LS, Sun Ah, Freeman DJ. Corticosteroids pharmacokinetics in the inner ear fluids: an
animal study followed by clinical application. Laryngoscope. 1999; 109: 1-17.
52. Shea Jr JJ. The role of dexamethasone or streptomycin perfusion tn the treatment of Meniere’s disease. Otolaryngologic Clinics of North America. 1997; 30: 1051-9.
53. Morales-Luckie E, Cornejo-Saurez A, Zaragoza-Contreras MA, Gonzalez-Perez O. Oral administration of prednisone to control refractory vertigo in Ménière's disease: a pilot study. Otol Neurotol 2005 Sept;26(5):1022-6.
54. Ariyasu L, Byl FM, Sprague MS, Adour KK. The beneficial effect of methylprednisolone in acute vestibular vertigo. Arch otolaryngol Head Neck Surg.1990 Jun;116(6):700-3.
55. Toshiaki Yamanaka, Masashi Sasa, Taku Amano, Hiroshi Miyahara and Takashi Matsunaga. Role of glucocorticoid in vestibular compensation in relation to activation of Vestibular Nucleus Neurons. Acta Oto-laryngologica 1995, Volume 115, No. s519, Pages 168-72.
56. Seemungal, Barry M.; Gresty, Michael A.; Bronstein, Adolfo M. The endocrine system, vertigo and balance. Current opinion in neurology; February 2001- Volume 14- Issue 1- PP 27-34.
57. Satyanarayana R. Pondugula, Joel D. Sanneman, Philine Wangemann, Pierre G. Milhaud and Daniel C. Marcus. AJP- Renal Physiol June 1, 2004 vol. 286 no. 6F1127-F1135.
58. Van Deelen GW, Huizing EH. Use of a diuretic (dyazide) in the treatment of Meniere’s disease. A double-blind cross-over placebo- controlled study. ORL; Journal of Otolaryngology and its related Specialities. 1986; 48: 287-92.
59. Salley Jr LH, Grimm M, Sismanis A, Spencer RF, Wise CM. Methotrexate in the management of immune mediated cochleovestibular disorders: clinical experience with 53 patients. Journal of Rheumatology. 2001; 28:1037-40.
60. Rascol O, Hain TC, Brefel C, Benazet M, Clanet M, Montastruc J. Antivertigo medication and drug induced vertigo-A pharmacological review. DRUGS 1995; 50 :777-791.
61. Kluysken P, Lambert P, D’Hooge D. Trimetazidine versus betahistine in vestibular vertigo: A double blind study. Ann OtolaryngolChir cervicofac 1990; 107 (Suppl-1): 20-27(French).
62. Drew S, Davies E. Effectiveness of Ginkgo biloba in treating tinnitis. Double blind placebo controlled trial. BMJ 2001; 322:73.
63. Hain TC. Alternative treatments for Miniere’s Disease. http://www.dizziness-and-
balance.com/disorders/miniere’s/men alt.html-9th January,2008.
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Published
2017-12-28
How to Cite
Khilnani, A. K., Thaddanee, R., & Khilnani, G. (2017). Anti vertigo Drugs-Revisited: Anti vertigo Drugs. National Journal of Integrated Research in Medicine, 4(4), 118–128. https://doi.org/10.70284/njirm.v4i4.574
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Review Article
