Drug Effects on Vestibular Testing

Timothy C. Hain, MD Page last modified: February 14, 2012

As a general rule, sedatives decrease vestibular responses such as measured with the ENG or Rotatory chair test, and stimulants increase vestibular responses.   The mechanism for these changes seems to be alertness - -in other words, if the vestibular tester can keep their subjects very awake, these drugs may not matter.

VEMP testing is probably the only vestibular test that is unaffected by drugs. (Vanspauwen, 2011) or cooperation.

Sedatives:

• Antihistamines (e.g. meclizine, dramamine) but NOT loratidine and other non-sedating antihistamines
• Antiemetics (e.g. promethazine, compazine, but NOT ondansetron)
• Sleeping pills (e.g. diazepam and relatives), but NOT Ambien taken more than 8 hours from testing.
• Barbituates (decrease responses in persons who are not alerted; COllins 1975)

Stimulants

• Caffeine
• Amphetamines (increase responses in sleep deprived persons; Collins 1988)

Recreational drugs.

• Ethanol if recent (e.g. 8 hours) causes a positional nystagmus
• Marijuana has no acute effect on vestibular function (Spector, 1974)
• Tobacco (nicotine) causes upbeating nystagmus (Sibony et al, 1987)
• Amphetamines -- increase vestibular responses

Common drugs that have little or no known effect on vestibular function

• Most blood pressure medications (e.g. diuretics, ACE inhibitors, beta-blockers)
• Statin medications
• Most antibiotics (main exception are intravenous "mycin" drugs).
• Ondansetron (antiemetic) and close relatives

see also: Instructions.html

References:

• Barmack, N. H. and V. E. Pettorossi (1980). "Vestibulo-ocular reflexes in rabbits: reduction by intravenous injection of diazepam." Archives of Neurology 37(11): 718-722.
• Collins, W. E., D. J. Schroeder, et al. (1975). "Effects of D-amphetamine and of secobarbital on optokinetic and rotation-induced nystagmus." Aviation, space, and environmental medicine 46(4 Sec 1): 357-364.
• Collins, W. E. (1988). "Some effects of sleep loss on vestibular responses." Aviation, space, and environmental medicine 59(6): 523-529.
• Rascol, O., T. C. Hain, et al. (1995). "Antivertigo medications and drug-induced vertigo. A pharmacological review." Drugs 50(5): 777-791.
• Sibony, P. A., C. Evinger, et al. (1987). "Tobacco-induced primary-position upbeat nystagmus." Annals of neurology 21(1): 53-58.
• Spector, M. (1974). "Chronic vestibular and auditory effects of marijuana." The Laryngoscope 84(5): 816-820.
• Vanspauwen, R., A. Weerts, et al. (2011). "No effects of anti-motion sickness drugs on vestibular evoked myogenic potentials outcome parameters." Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 32(3): 497-503.