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

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Total Respondents = 60

Type

Responses

% of Responses

Primary

7

11.67

Secondary

53

88.33

Table 23: Responses for category of patient having secondary to pre-existing ailment

Interpretation:
·         It was revealed through the study that 88.33% of the Consulting Physicians, observed patients with Secondary to pre-existing ailment.
·         Only 11.67% of Consulting Physicians observed Vertigo patients with Primary Vertigo.

5.      If it is secondary to pre-existing ailment, what is the most common pre-existing disease/disorder you see?

Total Respondents = 53 multiple responses (out of 60 Consulting Physicians)

Disorder

Responses

% of Responses

Diabetes Mellitus

50

53.76

Hypertension & Cardiac problems

32

34.41

ENT problems

3

3.23

Spondylosis

4

4.30

Otitis Media

1

1.08

Vit B12 deficiency

3

3.23

Table 24: Responses for patents having most common secondary to pre-existing ailment

Interpretation:
·         Diabetes Mellitus (53.76%) is the most common secondary to pre-existing ailment, followed by Hypertension & Cardiac problems (34.41%) amongst the Consulting Physicians.
·         Spondylosis (4.3%) along with ENT problems(3.23%) were also reported amongst Consulting Physicians respectively.
·         1.08% Consulting Physicians felt Otitis Media could be the pre-exiting case along with 3.23% Consulting Physicians who indicated Vit B12 Deficiency.

6.      What are the most common causes of Vertigo that you see in your practice?

Total Respondents = 60

Cause

Frequency of Ranks

Rank 1

Rank 2

Rank 3

Rank 4

Rank 5

Rank 6

 

BPPV

53

5

 

1

 

 

 

Labyrinthitis

4

38

4

2

 

 

 

Vestibular Neuronitis

2

9

14

2

 

 

 

Meniere’s Disease

 

5

13

2

 

 

 

Spondylosis

1

1

7

 

1

 

 
 

Migraine

 

 

 

 

2

 

Table 25: Table depicting the most common cause of Vertigo as ranked

Interpretation:
·         BPPV is the most common cause of Vertigo, followed by Labyrinthitis and Vestibular Neuronitis amongst the sampled Consulting Physicians.
·         Meniere’s Disease and Spondylosis were the other causes reported by the Consulting Physicians (in decreasing order of occurrence).
·         Migraine is the least significant cause of Vertigo.

7.      What is the usual line of treatment?

Total Respondents = 60 (multiple responses)

Line of Treatment

Responses

% of Responses

Lifestyle modification

1

1.35

Pharmacological

51

68.92

Manoeuvres only

1

1.35

Pharmacological and Manoeuvres

21

28.38

Table 26: Responses for usual line of treatment in Vertigo management

Interpretation:
·         Pharmacological therapy is the most preferred line of treatment amongst 68.92% Consulting Physicians for effective Vertigo management.
·         28.38% Consulting Physicians also resort to Pharmacological & Manoeuvres therapy for treating Vertigo.

8.      In pharmacological treatment what is your drug of choice?

Total Respondents = 60 (multiple responses)

Molecule

Responses

% of Responses

Betahistine

56

83.58

Cinnarizine

5

7.46

Dimenhydrinate

1

1.49

Combination

5

7.46

Any other

0

0

Table 27: Responses for molecule management in Vertigo management pharmacologically

Interpretation:
·         Betahistine is the most preferred drug of choice for treating vertigo amongst 83.58% Consulting Physicians.
·         1.49% Consulting Physicians prescribed Dimenhydrinate and 7.46% Consulting Physicians prefer to use a combination of drugs (Betahistine with Dimenhydrinate/Cinnarizine) or Cinnarizine solely for treating Vertigo.

9.      May I know your usual treatment approach?

 

8 mg

16mg

24mg

24mg C.R

48 mg C.R

OD

--

--

--

4

1

BID

4

14

3

--

--

TID

20

4

8

--

--

Table 28: Chart showing the type of Betahistine dose prescribed for treating Vertigo

Total Respondents = 60

Interpretation:
·         33.33% of the Consulting Physicians prefer to give 8mg TID dose of Betahistine to patients to treat vertigo.
·         23.33% of the Consulting Physicians prescribe 16mg BID dosage, while 13.33% of them prefer 24mg TID, for pharmacological therapy with Betahistine for Vertigo.
·            Only 6.67% of Consulting Physicians prescribes 24mg C.R once a day formulation (Betahistine O.D) for treatment in of Vertigo.
·            6.67% of Consulting Physicians prescribe 8mg BID & 5% of Consulting Physicians use 24mg as a BID dose for treating Vertigo.
·            Also, 1.67% Consulting Physicians prescribes 48mg OD of Betahistine to their patients.

Duration:

Total Respondents = 60

Duration

Responses

% of responses

1-2 weeks

44

73.33

3-4 weeks

16

26.67

4-8 weeks

0

0

Table 29: Responses for duration of pharmacological therapy for Vertigo

Interpretation:
·         1-2 weeks is the most preferred duration of therapy amongst 73.33% Consulting Physicians.
·         26.66% Consulting Physicians opted for 3-4 weeks therapy with Betahistine, while no one opted for more than 4 weeks

10.  Do you titrate dosage?

Total Respondents = 60

Response to question

Responses

% of Responses

Yes

57

95

No

3

5

Table 30: Responses for dosage titration in treating Vertigo

Interpretation:
·         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 was increased.
·         Where as 5% of the Consulting Physicians did not titrate the dosage.

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

Total Respondents = 60

Response to question

Responses

% of Responses

Yes

59

98.33

No

1

1.67

Table 31: Responses for Betahistine O.D awareness

Interpretation
·         Majority (98.33%) of the Consulting Physicians were found to be aware of Betahistine once a day preparation.
·         Only 1.67% Consulting Physicians were still unaware of Betahistine O.D formulation.

12.  If Yes, have you used?

Fig 29: Bar chart showing Betahistine once a day usage

Total Respondents = 60

Response to question

Responses

% of Responses

Yes

28

46.67

No

32

53.3

Table 32: Responses for Betahistine O.D usage

Interpretation:
·         53.33% of the Consulting Physicians did not use Betahistine O.D formulation, they reportedly used the conventional doses.
·         46.67% of the sampled Consulting Physicians, were found to use Betahistine O.D formulation.

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

Fig 30: Pie chart showing choice of Betahistine once a day preparation usage

Total Respondents = 28 (out of 60 Consulting Physicians)

Strength

Duration

Responses

% of Responses

Overall %

24 mg

1 week

8

28.57

60.71

2 weeks

9

32.14

4 weeks

0

0

 

48 mg

1 week

5

17.86

39.29

2 weeks

5

17.86

4 weeks

1

3.57

 
 
Table 33: Responses for preferred strength of Betahistine O.D usage

Interpretation:
·         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.
·         No Consulting Physician use 24mg OD formulation for 4 weeks
·         17.86% of Consulting Physicians use 48mg OD formulation for 1 week and 2 weeks respectively to treat Vertigo.
·         No Consulting Physician use 48mg OD formulation for 4 weeks

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

Total Respondents = 60

Response to question

Responses

% of Responses

Start with OD

32

53.33

Only Maintenance with OD

28

46.67

Table 34: Responses for preferred use of once a day formulation

Interpretation:
·         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.

15.   Is the usage of OD preparation indication specific?

Fig 32: Pie chart showing use of once a day preparation usage indication specifically

Total Respondents = 60

Response to question

Responses

% of Responses

Yes

2

3.33

No

58

96.67

Table 35: Responses for use of once a day formulation indication specifically

Interpretation:
·         Majority (96.67%) of the Consulting Physicians do not use O.D formulation particularly specific to any indication.
·         Only 3.33% of Consulting Physicians use it specific to any particular condition.

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

3.33% of the Consulting Physicians 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?

Fig 33: Pie chart showing use of two Anti-Vertigo molecules

Total Respondents = 60

Response to question

Responses

% of Responses

Yes

13

21.67

No

47

78.33

Table 36: Responses for usage of two Anti-vertigo molecules

Interpretation:
·         78.33% of the Consulting Physicians do not use two Anti-Vertigo molecules together.
·         Only 21.67% of the Consulting Physicians use two Anti-vertigo molecules together as a morning-evening dose.

If Yes, your usual approach

Sometimes Betahistine is prescribed 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 = 60

Response

Number of Responses

% of response

Yes

27

45

No

2

3.33

Maybe

4

6.67

Not tried

27

45

Table 37: Responses for usage of combination of Betahistine with Dimenhydrinate

Interpretation:
·         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.
·         3.33% of Consulting Physicians feel that this would not serve to be a good combination.

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