Vestibular suppressants associated with higher fall risk in dizzy patients
Almost one-third of older patients who presented with dizziness received a prescription for a vestibular suppressant, most commonly an antianxiety medication, and their risk of a fall was more than double that of patients who didn't get a prescription, a claims analysis found.
Vestibular suppressants are commonly incongruent with guideline-concordant care for dizziness and are also potentially counterproductive and injurious despite offering immediate relief from symptoms during an acute vestibular crisis, a study found.
Researchers analyzed a retrospective longitudinal database of U.S. commercial insurance and Medicare claims data (January 2006 to December 2015) for a comprehensive real-world cohort of individuals older than age 65 years. Results were published in the Journal of the American Geriatrics Society on Feb. 4.
Of 190,348 individuals ages 65 years or older who presented with dizziness, 60,658 (32%) filled a vestibular suppressant prescription within 30 days after diagnosis. Of these, 27% (n=16,159) obtained an antiemetic prescription such as meclizine or dimenhydrinate while 73% (n=44,499) obtained an antianxiety medication such as a benzodiazepine. Of those using vestibular suppressants, 8% had a fall resulting in a medical encounter within 60 days of filling the prescription. After adjustment for sociodemographics and comorbidities, patients who received vestibular suppressants were significantly more likely to experience recorded falls (hazard ratio [HR], 3.33 [95% CI, 1.93 to 5.72]; P<0.0001) than those who did not.
Patients who filled a prescription for an antiemetic or antianxiety drug were more than twice as likely to have a recorded fall encounter than those who did not (HRs, 2.17 [95% CI, 1.26 to 3.74] for antiemetic vs. no suppressants and 4.13 [95% CI, 2.40 to 7.12] for antianxiety vs. no suppressants). While both drug classes increased fall risk, the hazard ratio was higher for benzodiazepines than antiemetics, the study authors noted. Other factors associated with falls included having a higher comorbidity score and presenting first in the ED with dizziness rather than as an outpatient.
The study authors called for multifaceted interventions to improve the value of care for patients with vestibular disorders and to reduce routine use of the studied drugs.
“Both implementation and de-implementation efforts are essential in managing care for patients with dizziness,” the authors wrote. “Implementation efforts include achieving an accurate diagnosis and initiating the correct, etiologically based therapy to address the underlying disease, which is ultimately more patient-centered than managing symptoms with vestibular suppressants.”