Anti-vertigo drug prescribing for patients with vestibular symptoms in primary care

Background There is limited evidence that anti-vertigo drugs (AVDs) are effective in patients with vestibular symptoms. Still, betahistine is one of the most frequently prescribed off-label drugs. General practitioners (GPs) are likely to contribute substantially to these potentially inappropriate prescriptions.

Aim To evaluate the frequency of (long-term) AVD prescriptions in primary care and characteristics associated with long-term prescriptions.

Design and Setting We conducted a retrospective observational cohort study using anonymised routine primary care data from more than 1.2 million patients registered at 269 general practices throughout the Netherlands, covering the period 2018-2021.

Methods We included adult patients with vestibular symptoms and/or AVD prescriptions. Outcomes were the prevalence and incidence of (long-term) AVD prescriptions. We used a multivariable logistic regression analysis to identify characteristics associated with long-term prescriptions.

Results Among 73 650 patients with vestibular symptoms, 6172 patients (9.2%) received AVD prescriptions, and 32% of these were long-term. The majority of patients with prescriptions and long-term prescriptions (88% and 77%, respectively) had any other vestibular disorder than Ménière’s disease. Still, Ménière’s disease was associated with long-term prescriptions as well as increasing age. Patients with benign paroxysmal positional vertigo and a symptom diagnosis of lightheadedness were less likely to receive long-term prescriptions, in addition to patients registered at practices in extremely urbanised areas.

Conclusion AVD prescriptions, including long-term prescriptions, are common among patients with a wide array of vestibular symptoms and disorders, despite limited evidence. Management of vestibular symptoms by GPs can be improved by reducing these potentially inappropriate prescriptions.