Vertigo is a sensation of spinning or whirling, an illusion of motion that is distinct from general lightheadedness or feeling faint. This distressing feeling occurs when the brain receives conflicting signals about the body’s position in space from the eyes, sensory nerves, and inner ear. While many medical conditions can trigger this reaction, medications can also induce a sense of vertigo. Identifying a medication as the source of a balance problem is important for managing this adverse effect.
How Medications Affect Balance
Drugs interfere with the body’s complex balance system through two main physiological pathways: direct damage to the inner ear or broad effects on the central nervous system (CNS). The inner ear contains the vestibular system, which houses the semicircular canals responsible for detecting head movement and orientation. Certain medications are considered ototoxic, meaning they can chemically damage the sensory cells within this vestibular system, sometimes leading to permanent balance issues.
Ototoxicity often involves damage not only to the balance structures but also to the cochlea, leading to symptoms like hearing loss or ringing in the ears, known as tinnitus. The risk of ototoxicity can increase with higher doses, longer exposure, or when the drugs accumulate in the body due to factors like existing kidney issues.
Alternatively, many medications disrupt the balance centers in the brain and spinal cord. These CNS effects often manifest as sedation, drowsiness, or impaired coordination, which the brain interprets as a loss of balance. Drugs that alter the levels of neurotransmitters can reduce the brain’s ability to process balance information correctly. This mechanism typically results in temporary vertigo that resolves once the body adjusts to the drug or the medication is discontinued.
Major Drug Categories Linked to Vertigo
A wide variety of drug classes are known to cause vertigo. One of the most recognized classes for causing inner ear damage is the aminoglycoside antibiotics, including drugs like gentamicin, streptomycin, and tobramycin. These anti-infectives carry a high risk of ototoxicity that can result in vestibular damage.
Many medications that affect the nervous system also frequently list vertigo as an adverse reaction. Anticonvulsants, such as carbamazepine and lamotrigine, can cause balance issues by directly influencing brain chemistry and coordination centers. Similarly, sedatives and tranquilizers, particularly benzodiazepines like alprazolam and lorazepam, can induce vertigo through CNS depression by impairing central compensation.
Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are also frequent culprits. The vertigo often occurs when treatment begins or when the dosage is changed, reflecting the brain’s adjustment to altered serotonin levels. Antihypertensive medications can cause lightheadedness and a sensation of spinning. Diuretics, beta-blockers, and other vasodilators can lower blood pressure too quickly, leading to orthostatic hypotension—a sudden drop in pressure upon standing.
Chemotherapy agents, particularly platinum-based drugs like cisplatin and carboplatin, can cause severe ototoxicity and damage the balance structures of the inner ear, increasing the risk of falls. Certain over-the-counter and prescription anti-inflammatory drugs, including high doses of salicylates like aspirin, have also been associated with balance disturbances. Polypharmacy, the use of multiple medications, significantly increases the risk of experiencing these side effects due to complex drug interactions.
What to Do If Medication is Causing Vertigo
If you suspect a medication is causing you to feel a spinning sensation, contact your healthcare provider immediately. Do not stop taking any prescribed medication abruptly without first discussing it with the prescribing doctor or pharmacist. Stopping certain drugs, such as anticonvulsants or antidepressants, without supervision can lead to dangerous withdrawal symptoms or a worsening of the underlying condition.
When you speak with your doctor, be prepared to describe your symptoms, noting whether it is a true spinning sensation or general lightheadedness. Track the timing of the vertigo, such as whether it started with a new drug, a dose change, or if it occurs only when you change positions. Providing a list of all your medications, including supplements and over-the-counter drugs, is crucial, as interactions between them can often be the source of the problem.
The medical response will typically involve a structured review to determine if the drug is the likely cause. Depending on the drug and the severity of your symptoms, your doctor may suggest a dose reduction, a switch to a different medication within the same class, or a trial period to see if your body adjusts. For temporary relief, a doctor may prescribe motion sickness medications or antihistamines, though these should not be taken long-term as they can interfere with the brain’s natural recovery process.
Take practical steps to ensure your safety and prevent injury. Avoid activities that require balance, such as driving or operating heavy machinery, until the vertigo is controlled. Moving slowly when changing positions, such as sitting up slowly before standing, can help manage episodes related to blood pressure changes. Maintaining good hydration and reviewing your diet can also help to mitigate some forms of dizziness.