# Vertigo Management – Mapping prevalence and treatment. Understanding once a day preparation usage and place in therapy.

Table 9: Chart showing the type of Betahistine dose prescribed for treating Vertigo

Total Respondents = 40

 8 mg 16mg 24mg 24mg C.R 48 mg C.R OD -- -- -- 4 -- BID -- 4 8 -- -- TID 17 3 4 -- --

Interpretation:
·         42.5% of the Neurologists prefer to give 8mg TID dose of Betahistine to patients to treat vertigo.
·         20% of the Neurologists prescribe 24mg BID dosage, while 10% of them prefer 16mg BID or 24 mg TID dose, for pharmacological therapy with Betahistine for Vertigo.
·         Only 10% of Neurologists prescribes 24mg C.R once a day formulation (Betahistine O.D) for treatment in of Vertigo.
·         Also, 7.5% Neurologists prescribe 16mg TID of Betahistine to their patients.

Duration:

Total Respondents = 40

 Duration Responses % of responses 1-2 weeks 30 75 3-4 weeks 7 17.5 4-8 weeks 3 7.5

Table 10: Responses for duration of pharmacological therapy for Vertigo

Interpretation:
·         1-2 weeks is the most preferred duration of therapy with Betahistine amongst 75% Neurologists.
·         17.5% Neurologists opted for 3-4 weeks of therapy with Betahistine, while 7.5% preferred 4-8 weeks.

10)  Do you titrate dosage?

Total Respondents = 40

 Response to question Responses % of Responses Yes 36 90 No 4 10

Table 12: Responses for dosage titration in treating Vertigo

Interpretation:
·         90% of the Neurologists were found to titrate the dosage in Vertigo treatment.
·         With the usual approach being tapering down the dosage in patients where symptoms are relieved and do not recur, and then putting it off. But in some recurrent cases of vertigo the dosage was increased.
·         Where as 10% of the Neurologists did not titrate the dosage.

11)  Doctor, are you aware of once a day Betahistine preparation?

Total Respondents = 40

 Response to question Responses % of Responses Yes 38 95 No 2 5

Table 13: Responses for Betahistine O.D awareness

Interpretation:
·         Majority (95%) of the Neurologists were found to be aware of Betahistine once a day preparation. Only 5% Neurologists were still unaware of Betahistine O.D formulation.

12)  If Yes, have you used?

Total Respondents = 40

 Response to question Responses % of Responses Yes 22 55 No 18 45

Table 14: Responses for Betahistine O.D usage

Interpretation:
·         55% of the sampled Neurologists, were found to use Betahistine O.D formulation.
·         45% of the Neurologists did not use Betahistine O.D formulation, they reportedly used the conventional doses.

13)  If answer to Q11 is Yes, what is preferred strength & duration?

Fig 14: Pie chart showing choice of Betahistine once a day preparation usage

Total Respondents = 22 (out of 40 Neurologists)

 Strength Duration Responses % of Responses Overall % 24 mg 1 week 11 50 77.27 2 weeks 5 22.73 4 weeks 1 4.54 48 mg 1 week 0 0 22.73 2 weeks 3 13.64 4 weeks 2 9.09

Table 15: Responses for preferred strength of Betahistine O.D usage

Interpretation:
·         Amongst all Neurologists those who use Betahistine once a day preparation, 77.27% mostly prescribe 24mg C.R, while 22.73% use 48mg C.R formulation.
·         The duration for which 24mg C.R is prescribed the most is 1 week by 50% Neurologists, followed by 2 weeks amongst 22.73% Neurologists.
·         13.64% Neurologists use 48mg C.R for 2 weeks.
·         9.09% Neurologists use 48mg C.R for 4 weeks.

14)  If used, how do you use the OD formulation?

Total Respondents = 40

 Response to question Responses % of Responses Start with OD 27 67.5 Only Maintenance with OD 13 32.5

Table 16: Responses for preferred use of once a day formulation

Interpretation:
67.5% of the Neurologists prefer to use O.D formulation as a start up dose, while the rest (32.5%) preferred to use it as a maintenance dose only.

15)   Is the usage of OD preparation indication specific?

Total Respondents = 40

 Response to question Responses % of Responses Yes 7 17.5 No 33 82.5

Table 17: Responses for use of once a day formulation indication specifically

Interpretation:
·         Majority (82.5%) of the Neurologists do not use O.D formulation particularly specific to any indication.
·         Only 17.5% of Neurologists use it specific to any particular condition.

16)  If yes, which is the indication and any specific reasons?

17.5% of the Neurologists use O.D formulation in Acute cases of vertigo. They also prefer to use it in patients with severe symptoms.

17)  Do you also use two anti-vertigo molecules like morning/evening dose?

Total Respondents = 40

 Response to question Responses % of Responses Yes 4 10 No 36 90

Table 18: Responses for usage of two Anti-vertigo molecules

Interpretation:
·         90% of the Neurologists do not use two Anti-Vertigo molecules together.
·         Only 10% of the Neurologists use two Anti-vertigo molecules together as a morning-evening dose.

10% of the Neurologists use Betahistine with Dimenhydrinate or Cinnarizine.

18)  Do you think, combination of Betahistine with Dimenhydrinate is required? If yes, for which indication and condition is it useful?

Total Respondents = 40

 Response Number of Responses % of response Yes 15 37.5 No 4 10 Maybe 5 12.5 Not tried 16 40

Table 19: Responses for usage of combination of Betahistine with Dimenhydrinate

Interpretation:
·         40% of the Neurologists have not tried this combination, but 37.5% said it to be a potent and viable combination.
·         They were further aided by 12.5% of doctors who felt it maybe a fruitful combination.
·         10% of Neurologists feel that this would not serve to be a good combination.

CONSULTING PHYSICIANS

CONSULTING PHYSICIANS (SAMPLE SIZE = 60)
·         The incidence of 10-15% patients was found to be a majority amongst 43.33% Consulting Physicians, who have administered anti-vertigo medications.
·         The % of female patients who seek anti-vertigo medications were found to be on the higher side than Male patients amongst Consulting Physicians.
·         66.67% of the Consulting Physicians felt that a 40:60 (Male:Female) ratio is most observed in their practice.
·         66.67% Consulting Physicians reported that 40-50 years was the prevalent category of the patients.
·         It was revealed through the study that 88.33% of the Consulting Physicians, observed patients with Secondary to pre-existing ailment.
·         Diabetes Mellitus (53.76%) is the most common secondary to pre-existing ailment, followed by Hypertension & Cardiac problems (34.41%) amongst the Consulting Physicians.
·         BPPV is the most common cause of Vertigo, followed by Labyrinthitis and Vestibular Neuronitis amongst the sampled Consulting Physicians.
·         Pharmacological therapy is the most preferred line of treatment amongst 68.92% Consulting Physicians for effective Vertigo management.
·         Betahistine is the most preferred drug of choice for treating vertigo amongst 83.58% Consulting Physicians.
·         33.33% of the Consulting Physicians prefer to treat with 8mg TID dose of Betahistine for vertigo patients.
·         1-2 weeks is the most preferred duration of therapy amongst 73.33% Consulting Physicians.
·         95% of the Consulting Physicians were found to titrate the dosage in Vertigo treatment with.
·         With the usual approach being tapering down the dosage in patients where symptoms are relieved and do not recur, and then putting it off. But in some recurrent cases of vertigo the dosage is increased.
·         98.33% of the Consulting Physicians were found to be aware of Betahistine once a day preparation.
·         53.33% of the Consulting Physicians did not use Betahistine O.D formulation, they reportedly used the conventional doses.
·         Consulting Physicians those who use Betahistine once a day preparation, mostly (60.71%) prescribe 24mg C.R, while 39.29% use 48mg C.R formulation.
·         32.14% of Consulting Physicians prescribe 24mg C.R for 1 week, followed by 32.14% of Consulting Physicians for 2 weeks.
·         53.33% of the Consulting Physicians prefer to use O.D formulation as a start up dose, while the rest (46.67%) preferred to use it as a maintenance dose only.
·         96.67% of the Consulting Physicians do not use O.D formulation particularly specific to any indication.
·         78.33% of the Consulting Physicians do not use two Anti-Vertigo molecules together.
·         45% of the Consulting Physicians have not tried this combination, but 45% also said it to be a potent and viable combination.
·         They were further aided by 6.67% of doctors who felt it maybe a fruitful combination.

1.      In your practice what is the incidence of patients who need anti-vertigo medication?

Total Respondents = 60

 Category Responses Percentage of responses 5-10% 11 18.33 10-15% 26 43.33 15-25% 20 33.33 More than 25% 3 5

Table 20: Responses for incidence of patients requiring Anti-Vertigo Medication per week

Interpretation:
·             The incidence of 10-15% patients was found to be a majority amongst 43.33% Consulting Physicians, who have administered anti-vertigo medications.
·             The incidence of 15-25% & 5-10% patients were also reported amongst 33.33% & 18.33% Consulting Physicians respectively.
·             Only 5% of the Consulting Physicians reported of more than 25% patients requiring anti-vertigo medication.

2.      May I know the approximate bifurcation of patients gender wise (in %)?

Total Respondents = 60

 % of Patients Approx Ratio Responses % of Responses Male 40 40 66.67 Female 60 Male 50 14 23.33 Female 50 Male 30 5 8.33 Female 70 Male 20 1 1.67 Female 80

Table 21: Responses for gender bifurcation of patients requiring Anti-Vertigo Medication per week

Interpretation:
·         The % of female patients who seek anti-vertigo medications were found to be on the higher side than Male patients amongst Consulting Physicians.
·         66.67% of the Consulting Physicians felt that a 40:60 (Male:Female) ratio is most observed in their practice.
·         30:70 (Male:Female) ratio was observed amongst 8.33% Consulting Physicians.
·         1.67% Consulting Physicians observed an equal ratio of 50:50 (Male:Female) in their practice.%.

3.      Is it more predominant in any particular age group?

Total Respondents = 60

 Age of Patients Responses % of Responses Below 20 years 0 0 20-40 years 3 5 40-50 years 40 66.67 Above 50 years 17 28.33

Table 22: Responses for prevalent age group of patients requiring Anti-Vertigo Medication per week

Interpretation:
·         66.67% Consulting Physicians reported that 40-50 years was the prevalent category of the patients.
·         Patients above 50 years age was reported with 28.33% Consulting Physicians
·         5% Consulting Physicians found 20-40 years category to be more prevalent in their practice, while there were no patients reported below 20 years.

4.      Of these patients reported, do you get most patients as primary vertigo/dizziness patients or it is secondary to some pre-existing ailment?

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