Nutthiya Hanprasertpong, M.D., Ph.D.

Department of Pharmacology
Faculty of Medicine
Chiang Mai University
You should be able to
Describe the indications and adverse drug reactions of
the commonly used topical otic drugs
Describe the indications and adverse drug reactions of
vestibular suppressants dawnwomenas
Describe the indications and adverse drug reactions of
drugs used to increase inner ear hemodynamic
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Topical otic drugs
Wax softening drops
Antibiotic ear drops
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Acidifying agents notion

Drugs used in acute vertigo

Vestibular suppressants
Antiemetics
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Drugs used to increase blood
supply to the inner ear
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1. 3% Hydrogen peroxide in glycerin (1:1)

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2. Sodium bicarbonate
3. Docusate admonish

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(bacterial otitis
externa)

: P. aeruginosa or S. aureus

Ullevaal
1. Chloramphenicol
2. Quinolone: ofloxacin, levofloxacin
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3. Neomycin +/- polymyxin no7loooivin
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 Active agents Main spectrum Side effects
Polymyxin B and E Gram negative bacteria, Less/few
Enterobacter
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Gram positive and negative Contact dermatitis
bacteria (*Staphylococcus*) Inner ear toxicity
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Chloramphenicol t Gram positive and negative Inner ear toxicity (animal
bacteria study)
Anaerobe
Gentamicin Gram negative bacteria Inner ear toxicity
Lonahininian
no
Quinolone Gram positive and negative No inner ear toxicity
in
bacteria (*Pseudomonas*) birdman
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Nitrofurantoin t Gram positive and negative Contact dermatitis (often)
bacteria Inner ear toxicity
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Alkaline pH is a risk factor for otitis externa (OE) goral
Restoring natural acidity of EAC can inhibit the growth of
pathogenic
Treatment: mild OE with minimal otalgia (
Pains y mm
Side effects: pain to
and local irritation ( compliance)
riote.g., alcohol-vinegar solution, acetic acid in aluminum
wins
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acetate drops, propylene glycol and acetic acid otic solution

Burow s solution
Aluminum acetate otic drops
Acidifying agents
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Treatment: uncomplicated otomycosis, mild bacterial OE
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Side effects:
On Otomycosis

Local anesthetics corn

Hf e.g., lidocaine, benzocaine

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Inner ear toxicity mowulodririsalsinia
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A hallucination of self- or environmental movement
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Most common: feeling of spinning
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Usually due to a disturbance of vestibular system
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1. Vestibular suppressants
2. Antiemetics pt NNma looks and

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1. Drugs that reduce nystagmus (eye movements) caused
by a vestibular imbalance
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2. Drugs that reduce motion sickness namrruewoominom
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Anticholinergics
Antihistamines
Benzodiazepines

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Agents with central anticholinergic effects
Increase motion tolerance indowlmatoinow

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Unlike antihistamines, pure anticholinergics are ineffective
if administered after symptoms have already appeared
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Side effects: dry mouth, dilated pupils, and sedation
Diphenidol SE:
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Used for prevention and symptomatic treatment of
peripheral vertigo and associated nauseaw and vomiting
Mechanism: not fully elucidated (antagonist at M1, M2, M3
and M4 receptors)
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e.g., dimenhydrinate, meclizine, cyclizine

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All the antihistamines (in general) used for control of
Pt his
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vertigo also have anticholinergic activity

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block H1 and M receptors at vestibular nuclei
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Side effects
Block H1 receptors: sedation
Block M receptors: dry throat, constipation, dysuria,
blurred vision
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Impaired vestibular compensation
to ptviavertigo
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e.g., diazepam, lorazepam,

clonazepam
Acting centrally to suppress
vestibular responses incell9 mainnerveactionpotentialonorw

Extremely useful in small

doses
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compensation mud
Long-acting benzodiazepines
are not helpful for relief of gerund
Gabaareceptor

vertigo s
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Side effects: addiction,

impaired memory, increased
risk of falling, and impaired
vestibular compensation
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Vertigo Dizziness

Drugs used to increase

blood supply to the
inner ear and brain
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Hearing loss Tinnitus

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Synaptic input impinging
in the vestibular nucleus
neurons E. Soto et al. Journal of Vestibular Research, 2013
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Analog of histamine
Mechanism: antagonist on H3 receptors
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gautoreceptor
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weak agonist effect on H1 and H2 receptors

Pironiosudulu
blood flow in the inner ear
inhibitory action in vestibular nuclei neurons
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Clinical uses: Ménière s00
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disease (vertigo, ru
rimtinnitus, hearing loss)
histamine
Side effects: gastric upset, aggravation of asthma, should not
used in patient with hepatic dysfunction O
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Clinical studies
incidence and severity of vertigo and nausea/vomiting
Most effective when compared with cinnarizine, clonazepam,
flunarizine or Ginkgo biloba
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Mechanism: block the L-type calcium channel
O hryvnia
block the pressure sensitive potassium channels
(cinnarizine)
block H1 receptors
block nicotinic receptor (very weak)
neurotransmitter release at synaptic terminals
calcium-activated potassium currents
blood flow to the brain
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Clinical uses: vertigo or dizziness
Side effects: sleepiness and weight gain
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Dried green leaf extracts
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Mechanism: antioxidant
platelet aggregation
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dilate small vessels

viscosity of blood
modulating effects on the glutamatergic,
cholinergic, dopaminergic and serotonergic systems
Clinical uses: vertigo, dizziness, ora tinnitus em
Side effects: (rare) nausea, vomiting, diarrhea, headaches,
dizziness, palpitations, restlessness, weakness, skin rash
look
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Ergot alkaloid derivative
Mechanism: Wonder
-1 receptor antagonist (vasodilate, blood flow)
cholinergic and catecholaminergic function
Inhibits platelet aggregation
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Promotes metabolic activity ( utilization of O2 and glucose)
Neurotrophic and antioxidant properties
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Clinical uses: balance disorders, tinnitus
Side effects: very slight GI distress, hypotension, flushing,
sleepiness & insomnia may occur very rarely
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Mechanism:
Inhibit voltage-dependent Na+ channel ( neuronal damage)
Inhibit PDE type I ( cAMP circulation, platelet aggregation
Antioxidant
cerebral metabolic rate
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erythrocyte flexibilityn by
Inhibits platelet aggregation
Clinical uses: tinnitus, Ménière s disease
Side effects: flushing, rashes, minor GI problems
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Idiopathic endolymphatic hydrops
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Symptoms: episodic vertigo 1hr1 in
(20 min to 24 h), fluctuating
sensorineural hearing loss, tinnitus, and aural fullness
Treatment: Teodorooinuirov
In acutely vertiginous patient
NM
Juhi
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5 2 Vestibulosuppressants and antiemetic drugs are prn used
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During quiescent phase vido
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Diuretic ?
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Vasodilators: betahistine bd
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Avoiding trigger substances e.g., salt, chocolate, caffeine,
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tobacco, alcohol, stress
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