DEAR DR. ROACH: My 86-year-old mother wears hearing aids, has tinnitus and is constantly dizzy. She also has atrial fibrillation, high blood pressure and some anxiety issues. <\/p>\n
She has had several urinary tract infections in the past few years. We have been to a neurologist, EN&T specialist, physical therapist and a chiropractor, and have had tests upon tests to determine the cause of her dizziness. <\/p>\n
The best that we have been told is that it is probably a form of vertigo. Unfortunately, it is not the crystals in her head that need rearranging. She is most dizzy in the mornings.<\/p>\n
She is currently taking amiodarone, nifedipine, methenamine, levothyroxine, metoprolol, Eliquis, a generic calm pill and cranberry supplement, buspirione, sertraline, cyclobenzaprine and cephalexin.<\/p>\n
Most of these medications have \u201cdizziness\u201d as a side effect. It is possible that her medications are the cause of her dizziness? We would love to take her off everything and restart them one by one to see if we can determine the cause, but her doctors are not particularly receptive to this. <\/p>\n
Do we have any hope in helping her? \u2014 T.L.<\/p>\n
ANSWER: Hearing loss, tinnitus and dizziness are suggestive of Meniere\u2019s disease, which can look just like regular episodes of vertigo. On hearing testing, the hearing loss looks different from common hearing loss of aging. <\/p>\n
Her ENT doctor should have noticed that if she had formal hearing testing done (which she should have since she has hearing aids).<\/p>\n
Many people like your mother are also treated with medication, such as meclizine (Antivert and Dramamine, among others), which are effective short term but taken long-term can keep the brain from ever adapting, meaning the vertigo will last forever. <\/p>\n
I avoid prescribing these drugs and will use in severe cases only for a few days at most.<\/p>\n
Of the drugs you list, many can cause \u201cdizziness\u201d, which can also mean lightheadedness or being off-balance.<\/p>\n
True vertigo, when there is a sense of motion when a person isn\u2019t moving, can be caused by at least one of the drugs on that list (sertraline). However, you say a \u201cgeneric calm pill\u201d, and if that is a benzodiazepine like diazepam (Valium) or clonazepam (Klonopin), these also may cause vertigo. <\/p>\n
I think it is entirely possible one or more of her medications could be causing, or at least worsening, her symptoms.<\/p>\n
While some medicines shouldn\u2019t be stopped lightly (the amiodarone, for example, can rarely cause vertigo, but only her cardiologist should change that), it might indeed be worthwhile trying to remove the most likely drugs to cause vertigo. <\/p>\n
Cyclobenzaprine is NOT a good drug for long-term use in anyone, especially a person in their 80s.<\/p>\n
Geriatricians probably have more experience in getting rid of prescriptions than most other physicians, and a geriatric consultant would be worthwhile.<\/p>\n
Finally, there is a resource that you haven\u2019t mentioned, but one I find invaluable in cases of vertigo that doesn\u2019t go away, and that is vestibular rehabilitation. This is performed by specially trained occupational and physical therapists. I consider it a precious resource and refer only patients who really need it. <\/p>\n
Even where I practice, which is very well supplied with health professionals, there are not<\/p>\n
enough spots in vestibular rehab for every patient with dizziness.<\/p>\n