Vertigo

Sensation of rotation or movement at rest. International practice (AAN 2024, Barany Society) starts with identifying the cause: benign positional vertigo (Epley manoeuvre), Meniere's disease, vestibular neuritis, vestibular migraine, central causes. Treatment follows the specific diagnosis. Cinnarizine and 'vascular therapy' are not first-line.

ICD-10 H81.94 drugs

Also known as: Dizziness, Vestibular vertigo

Drugs used for this condition

BFlunarizineSecond line · Selective calcium channel blocker, antivertigo and migraine prophylaxis agentFor central and peripheral vestibular vertigo, including Ménière's disease. Dose 5–10 mg once daily at bedtime. Limit to 6–12 months – longer use increases extrapyramidal and depression risk. Not used for benign paroxysmal positional vertigo (Epley maneuvers are first-line).
CBetahistineSecond line · Histamine analogue, antivertigo agentUsed symptomatically in peripheral vestibular vertigo. The 2016 Cochrane meta-analysis showed moderate effect on vertigo intensity and frequency versus placebo with low certainty. Not used in benign paroxysmal positional vertigo (BPPV) – otolith repositioning maneuvers are first-line there.
CCinnarizineSecond line · Calcium channel blocker with antihistamine activityUsed in vestibular vertigo from various causes as a symptomatic agent. Dose 25–50 mg three times daily. Cochrane 2018 showed moderate efficacy over placebo with low certainty. Not recommended in patients over 65 (Beers 2023) – falls, cognitive impairment, and drug-induced parkinsonism risk outweigh the modest symptomatic benefit. Course limited to 4 weeks.

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

FPiracetam + cinnarizineNot recommended · Combination nootropic (local classification)In Russian practice, Fezam and Omaron are popular for 'dizziness', but AAN 2024 and Barany Society guidelines require a specific diagnosis – BPPV, Meniere's, vestibular neuritis, vestibular migraine – and condition-specific treatment. The fixed piracetam-cinnarizine combination is not in these documents. Cinnarizine in older adults, especially with prolonged use, can cause drug-induced parkinsonism.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit