Лекарственно-индуцированное головокружение

Остроумова О.Д., Акимова Е.С., Шаповалова М.В. Лекарственно-индуцированное головокружение. Consilium Medicum. 2019; 21 (9): 110–119. DOI: 10.26442/20751753.2019.9.190393

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Ostroumova O.D., Akimova E.S., Shapovalovа M.V. Drug-induced dizziness. Consilium Medicum. 2019; 21 (9): 110–119. DOI: 10.26442/20751753.2019.9.190393

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Аннотация

У больных пожилого и старческого возраста головокружение является одним из наиболее часто встречающихся симптомов: его распространенность у лиц старше 65 лет достигает 30%. Головокружение негативно влияет на качество жизни пожилых людей, повышает риски падения. Четкого и единого понятия головокружения не существует. Термин «головокружение» является общим, используемым пациентами для субъективного описания жалоб и симптомов, связанных с разнообразными изменениями ощущений, чувства движения, восприятия или сознания. Специалисты чаще всего классифицируют головокружение на системное (истинное, вертиго) и несистемное. Головокружение в пожилом возрасте представляет собой гериатрический синдром, т.е. может быть вызвано несколькими одновременно действующими факторами, связанными с нарушением функционирования многих органов и систем, поэтому у людей старших возрастных групп поиск причины головокружения затруднен. У 40% пожилых пациентов, предъявляющих жалобы на головокружение, врачи не могут точно установить причину этого симптома, так как головокружение может изначально иметь полиэтиологическое происхождение. К причинам, вызывающим головокружения/вертиго, относятся и определенные лекарственные средства, при применении которых развивается такая нежелательная побочная реакция, как головокружение. В таком случае употребляют термин «лекарственно-индуцированное головокружение/вертиго». К классам препаратов, которые наиболее часто приводят к возникновению головокружения/вертиго, относятся противосудорожные препараты, анестетики, антигипертензивные препараты, антидепрессанты, анальгетики, сахароснижающие препараты, противозачаточные средства, противовоспалительные препараты, препараты для лечения заболеваний сердечно-сосудистой системы, седативные средства, транквилизаторы и цитотоксические средства. Оценивая причину головокружения/вертиго у лиц старших возрастных групп, обязательно следует принимать во внимание его возможную причинно-следственную связь с приемом какого-либо лекарственного средства. В этом случае необходимо снижение дозы данного лекарственного средства или полная его отмена (замена на другой препарат, не вызывающий данного побочного эффекта). Современная диагностика и лечение головокружений у больных пожилого и старческого возраста невозможна без привлечения врачей разных специальностей в силу полиэтиологичности данного гериатрического синдрома, с обязательной оценкой/ревизией листа лекарственных назначений.

Ключевые слова: головокружение, вертиго, лекарственно-индуцированное головокружение, лекарственно-индуцированное вертиго, нежелательные побочные реакции лекарственных средств, пожилой и старческий возраст.

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In elderly and senile patients, dizziness is one of the most common symptoms: its prevalence in persons older than 65 years reaches 30%. Dizziness has a negative impact on the quality of life of the elderly, increases the risk of falling. There is no clear and unified concept of "dizziness". The term "dizziness" is a generic term used by patients to subjectively describe complaints and symptoms associated with a variety of changes in sensation, sense of movement, perception, or consciousness. Specialists often classify dizziness into systemic (true, vertigo) and non-systemic. Dizziness in the elderly is a geriatric syndrome, i.e. it can be caused by several simultaneously acting factors associated with the disruption of the functioning of many organs and systems, so in people of older age groups, the search for the cause of dizziness is difficult. 40% of elderly patients, presenting complaints of dizziness, doctors can not accurately determine the cause of the symptoms, as dizziness may initially have polietiologichesky origin. The causes of dizziness/vertigo include certain drugs, the application of which develops such an undesirable side reaction as dizziness. In this case, the term drug-induced dizziness/vertigo is used. The classes of drugs that most often lead to dizziness/vertigo include anticonvulsants, anesthetics, antihypertensive drugs, antidepressants, analgesics, hypoglycemic drugs, contraceptives, anti-inflammatory drugs, drugs for the treatment of diseases of the cardiovascular system, sedatives, tranquilizers and cytotoxics. When assessing the cause of dizziness/vertigo in persons of older age groups, it is necessary to take into account its possible causal relationship with the intake of any drug. In this case, it is necessary to reduce the dose of this drug or its complete abolition (replacement with another drug that does not cause this adverse effect). Modern diagnosis and treatment of dizziness in elderly and senile patients is impossible without the involvement of doctors of different specialties due to the polyetiology of this geriatric syndrome, with the obligatory assessment/revision of the sheet of medicinal prescriptions.

Key words: dizziness, vertigo, drug-induced dizziness, drug-induced vertigo, adverse drug reaction, оlder age.

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Список литературы

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29. Stanton VA, Hsieh YH, Camargo CAJr. Overreliance on symptom quality in diagnosing dizziness: results of a multicenter survey of emergency physicians. Mayo Clin Proceedings 2007; 82 (11): 1319–28.
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36. Palomar GV, Abdulghani MF, Bodet AE et al. Drug-induced ototoxicity: current status. Acta Oto-Laryngologica 2001; 121 (5): 569–72.
37. Mick P, Westerberg BD. Sensorineural hearing loss as a probable serious adverse drug reaction associated with low-dose oral azithromycin. J Otolaryngology Head Neck Surg 2007; 36 (5): 257–63.
38. Verdel BM, van Puijenbroek EP, Souverein PC et al. Drug-related nephrotoxic and ototoxic reactions: a link through a predictive mechanistic commonality. Drug Safety 2008; 31 (10): 877–884. DOI: 10.2165/00002018-200831100-00006

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1. Maarsingh OR, Dros J, Schellevis FG et al. Dizziness reported by elderly patients in family practice: prevalence, incidence, and clinical characteristics. BMC Family Practice 2010; 11 (2). DOI: 10.1186/1471-2296-11-2
2. Stam H, Harting T, van der Sluijs M et al. Usual care and management of fall risk increasing drugs in older dizzy patients in Dutch general practice. Scandinavian J Primary Health Care 2016; 34 (2): 165–71. DOI: 10.3109/02813432.2016.1160634
3. Aggarwal NT, Bennett DA, Bienias JL et al. The prevalence of dizziness and its association with functional disability in a biracial community population. J Gerontol Biol Sci Med Sci 2000; 55 (5): 288–92. PMID: 10819319
4. Cigolle CT, Langa KM, Kabeto MU et al. Geriatric conditions and disability: The Health and Retirement Study. Ann Int Med 2007; 147 (3): 156–64. PMID: 17679703
5. Kammerlind AS, Håkansson JK, Skogsberg MC. Effects of balance training in elderly people with nonperipheral vertigo and unsteadiness. Clin Rehabilitation 2001; 15 (5): 463–70. DOI: 10.1191/026921501680425180
6. Lasisi AO, Gureje O. Disability and quality of life among community elderly with dizziness: report from the Ibadan study of ageing. J Laryngology Otology 2010; 124 (9): 957–62. DOI: 10.1017/S0022215110000538
7. Tinetti ME, Williams CS, Gill TM. Dizziness among older adults: a possible geriatric syndrome. Ann Int Med 2000; 132 (5): 337–44.
8. Dros J, Maarsingh OR, Beem L et al. Impact of dizziness on everyday life in older primary care patients: a cross-sectional study. Health Qual Life Outcomes 2011; 9 (1): 44. DOI: 10.1186/1477-7525-9-44
9. Mueller M, Strobl R, Jahn K. Impact of vertigo and dizziness on self-perceived participation and autonomy in older adults: results from the KORA-Age study. Quality of Life Research 2014; 23 (8): 2301–8. DOI: 10.1007/s11136-014-0684-x
10. Olsson Möller U, Hansson EE, Ekdahl C et al. Fighting for control in an unpredictable life – a qualitative study of older persons' experiences of living with chronic dizziness. BMC Geriatrics 2014; 14: 97. DOI: 10.1186/1471-2318-14-97
11. Stam H, Wisse M, Mulder B et al. Dizziness in older people: at risk of shared therapeutic nihilism between patient and physician. A qualitative study. BMC Family Practice 2016; 17: 74. DOI: 10.1186/s12875-016-0474-3
12. Tinetti ME, Williams CS, Gill TM. Health, functional, and psychological outcomes among older persons with chronic dizziness. J Am Geriatrics Society 2000; 48 (4): 417–21.
13. Deandrea S, Lucenteforte E, Bravi F et al. Risk Factors for Falls in Community-dwelling Older People. Epidemiology 2010; 21 (5): 658–68. DOI: 10.1097/EDE.0b013e3181e89905
14. Chimirri S, Aiello R, Mazzitello C et al. Vertigo/dizziness as a Drugs’ adverse reaction. J Pharmacol Pharmacotherapeut 2013; 4 (1): 104–9. DOI: 10.4103/0976-500X.120969
15. Dieterich M. Dizziness. Neurologist 2004; 10 (3): 154–64.
16. Saccomano SJ. Dizziness, vertigo and presyncope: What's the difference? Nurse Prac 2012; 37 (12): 46–52. DOI: 10.1097/01.NPR.0000422206.92550.5b
17. Parfenov V.A., Ostroumova T.M., Ostroumova O.D. Arterial'naia gipertenziia i golovokruzhenie: sushchestvuet li vzaimosviaz'? Ratsional'naia farmakoterapiia v kardiologii. 2019; 15 (1): 125–9. DOI: 10.20996/1819-6446-2019-15-1-125-129 (in Russian).
18. Zamergrad M.V. Osnovnye problemy diagnostiki i lecheniia vestibuliarnogo golovokruzheniia. Nevrologiia, neiropsikhiatriia, psikhosomatika. 2010; 2 (3): 17–21. DOI: 10.14412/2074-2711-2010-95 (in Russian).
19. Bestuzheva N.V. Parfenov V.A., Zamergrad M.V. Dobrokachestvennoe paroksizmal'noe pozitsionnoe golovokruzhenie u zhenshchiny s arterial'noi gipertenziei i meningiomoi. Zhurn. nevrologii i psikhiatrii im. S.S.Korsakova. 2014; 114 (4). PMID: 24874329 (in Russian).
20. Hamann KF. Benign paroxysmal positioning vertigo: a disease explainable by inner ear mechanics. J ORL Relat Spec 2006; 68 (6): 329–33. DOI: 10.1159/000095285
21. Hornibrook J. Benign Paroxysmal Positional Vertigo (BPPV): History, Pathophysiology, Office Treatment and Future Directions. Int J Otolaryn 2011; 2011: 1–13. DOI: 10.1155/2011/835671
22. Jacob RG, Furman JM. Psychiatric consequences of vestibular dysfunction. Cur Opinion Neuro 2001; 14 (1): 41–6.
23. Kao AC, Nanda A, Williams CS, Tinetti ME. Validation of dizziness as a possible geriatric syndrome. J Am Geriatrics Society 2001; 49 (1): 72–5.
24. Gassmann KG, Rupprecht R. Dizziness in an older community dwelling population: a multifactorial syndrome. J Nutr Health Ag 2009; 13 (3): 278–82.
25. Gomez F, Curcio CL, Duque G. Dizziness as a geriatric condition among rural community-dwelling older adults. J Nutr Health Ag 2011; 15 (6): 490–7.
26. Kerber KA, Newman-Toker DE. Misdiagnosing dizzy patients. Common pitfalls in clinical practice. Neuro Clin 2015; 33 (3): 565–75. DOI: 10.1016/j.ncl.2015.04.009
27. Newman-Toker DE, Cannon LM, Stofferahn ME et al. Imprecision in patient reports of dizziness symptom quality: a cross-sectional study conducted in an acute care setting. Mayo Clinic Proceedings 2007; 82 (11): 1329–40. DOI: 10.4065/82.11.1329
28. Muncie HL, Sirmans SM, James E. Dizziness: Approach to Evaluation and Management. Am Fam Phy 2017; 95 (3): 154–62.
29. Stanton VA, Hsieh YH, Camargo CAJr. Overreliance on symptom quality in diagnosing dizziness: results of a multicenter survey of emergency physicians. Mayo Clin Proceedings 2007; 82 (11): 1319–28.
30. Maarsingh OR, Dros J, Schellevis FG. Causes of persistent dizziness in elderly patients in primary care. Ann Fam Med 2010; 8 (3): 196–205. DOI: 10.1370/afm.1116
31. Sychev DA. Polypharmacy in clinical practice: a problem and solutions. A manual for doctors. Saint Petersburg: Professiia, 2016 (in Russian).
32. Shoair OA, Nyandege AN, Slattum PW. Medication-related dizziness in the older adult. Otolaryngol Clin North Am 2011; 44 (2): 455–71. DOI: 10.1016/j.otc.2011.01.014
33. Cianfrone G, Pentangelo D, Cianfrone F et al. Pharmacological drugs inducing ototoxicity, vestibular symptoms and tinnitus: a reasoned and updated guide. Eur Rev Med Pharmacol Sci 2011; 15 (6): 601–36.
34. Wong J, Philip J, Hilas O. Management of Dizziness and Vertigo. US Pharmacist 2012; 37 (1): 30–3.
35. Medicine-induced Vertigo Prescriber Update. 2017; 38 (1): 12–3. https://medsafe.govt.nz/profs/PUArticles/March2017/MedicineInducedVertigo.htm
36. Palomar GV, Abdulghani MF, Bodet AE et al. Drug-induced ototoxicity: current status. Acta Oto-Laryngologica 2001; 121 (5): 569–72.
37. Mick P, Westerberg BD. Sensorineural hearing loss as a probable serious adverse drug reaction associated with low-dose oral azithromycin. J Otolaryngology Head Neck Surg 2007; 36 (5): 257–63.
38. Verdel BM, van Puijenbroek EP, Souverein PC et al. Drug-related nephrotoxic and ototoxic reactions: a link through a predictive mechanistic commonality. Drug Safety 2008; 31 (10): 877–884. DOI: 10.2165/00002018-200831100-00006

Авторы

О.Д. Остроумова*1,2, Е.С. Акимова1, М.В. Шаповалова2,3

1 ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России, Москва, Россия;
2 ОСП «Российский геронтологический научно-клинический центр» – ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России Москва, Россия;
3 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия
*ostroumova.olga@mail.ru

________________________________________________

Olga D. Ostroumova*1,2, Elizaveta S. Akimova1, Mariia V. Shapovalova2,3

1 Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia;
2 Russian Clinical and Research Center of Gerontology, leading department of Pirogov Russian National Research Medical University, Moscow, Russia;
3 Russian Medical Academy of Continuous Professional Education, Moscow, Russia
*ostroumova.olga@mail.ru

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