Drugs Used in Nausea and Vertigo

Management of vestibular diseases is aimed at treating the underlying cause as well as treating symptoms of the balance disturbance and associated nausea and vomiting. Vertigo and nausea associated with Ménière’s disease and middle-ear surgery can be difficult to treat.Betahistine is an analogue of histamine and is claimed to reduce endolymphatic pressure by improving the microcirculation. Betahistine is licensed for vertigo, tinnitus, and hearing loss associated with Ménière’s disease.

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Drugs Used in the Treatment of Obesity

An anti-obesity drug should be considered only for those with a body mass index (BMI, individual’s body-weight divided by the square of the individual’s height) of 30 kg/m2 or greater in whom at least 3 months of managed care involving supervised diet, exercise and behaviour modification fails to achieve a realistic reduction in weight. In the presence of risk factors (such as diabetes, coronary heart disease, hypertension, and obstructive sleep apnoea), it may be appropriate to prescribe a drug to individuals with a BMI of 27 kg/m2 or greater, provided that such use is permitted by the drug’s marketing authorisation.

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Other Antidepressant Drugs

Mirtazapine, a presynaptic alpha2-adrenoreceptor antagonist, increases central noradrenergic and serotonergic neurotransmission. It has few antimuscarinic effects, but causes sedation during initial treatment. Venlafaxine is a serotonin and noradrenaline re-uptake inhibitor (SNRI); it lacks the sedative and antimuscarinic effects of the tricyclic antidepressants. Tianeptine is an antidepressant agent with a novel neurochemical profile. It increases serotonin (5-hydroxytryptamine; 5-HT) uptake in the brain (in contrast with most antidepressant agents) and reduces stress-induced atrophy of neuronal dendrites. Like the selective serotonin reuptake inhibitors (SSRIs) and in contrast with most tricyclic antidepressant agents, tianeptine does not appear to be associated with adverse cognitive, psychomotor, sleep, cardiovascular or bodyweight effects and has a low propensity for abuse.

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Tricyclic and related antidepressant drugs

Tricyclic and related antidepressants block the re-uptake of both serotonin and noradrenaline, although to different extents. Tricyclic and related antidepressants also show varying degrees of antimuscarinic side-effects and cardiotoxicity in overdosage, which may be important in individual patients. Evidence of the efficacy of tricyclic antidepressants for depression in children has not been established.

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Antidepressant Drugs

Antidepressant drugs are effective for treating moderate to severe depression associated with psychomotor and physiological changes such as loss of appetite and sleep disturbance; improvement in sleep is usually the first benefit of therapy.

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Antipsychotic Depot Injection

Long-acting depot injections are used for maintenance therapy especially when compliance with oral treatment is unreliable. However, depot injections of conventional antipsychotics may give rise to a higher incidence of extrapyramidal reactions than oral preparations; extrapyramidal reactions occur less frequently with atypical antipsychotics such as risperidone. Depot antipsychotics are administered by deep intramuscular injection at intervals of 1 to 4 weeks. When initiating therapy with sustained-release preparations of conventional antipsychotics, patients should first be given a small test-dose as undesirable side-effects are prolonged. In general not more than 2–3 mL of oily injection should be administered at any one site; correct injection technique (including the use of z-track technique) and rotation of injection sites are essential. If the dose needs to be reduced to alleviate side-effects, it is important to recognise that theplasma-drug concentration may not fall for some time after reducing the dose; therefore it may be a month or longer before side-effects subside. ​



Indications: maintenance in schizophrenia and other psychoses.

Contraindications: hepatic impairment; renal impairment; pregnancy; breast-feeding.

Dose and Administration: By deep intramuscular injection into the gluteal muscle, test dose 20 mg, then after at least 7 days 20–40 mg repeated at intervals of 2–4 weeks, adjusted according to response; max. 400 mg weekly; usual maintenance dose 50 mg every 4 weeks to 300 mg every 2 weeks; elderly initially quarter to half adult dose; child not recommended.



Indications: Bipolar Disorder in Remission, Schizophrenia and other psychoses in patients tolerant to risperidone by mouth.

Contraindications: Akathisia, Constipation, Dizziness, Drowsy, Dyspepsia, Extrapyramidal Disease, Fatigue, Headache Disorder, Parkinsonism, Rhinitis, Weight Gain, Xerostomia.

Dose and Administration: By deep intramuscular injection into the gluteal muscle, patients taking oral risperidone up to 4 mg daily, initially 25 mg every 2 weeks; patients taking oral risperidone over 4 mg daily, initially 37.5 mg every 2 weeks; dose adjusted at intervals of at least 4 weeks in steps of 12.5 mg to max. 50 mg (elderly 25 mg) every 2 weeks; child and adolescent under 18 years not recommended.



Indications: maintenance in schizophrenia and other psychoses, particularly with aggression and agitation.

Contraindications: hepatic impairment; renal impairment; pregnancy; breast-feeding.

Dose and Administration: By deep intramuscular injection into the gluteal muscle, test dose 100 mg, followed after at least 7 days by 200–500 mg or more, repeated at intervals of 1–4 weeks, adjusted according to response; max. 600 mg weekly; elderly quarter to half usual starting dose; child not recommended. ​

Atypical Antipsychotics

The ‘atypical antipsychotics’ may be better tolerated than other antipsychotics; extrapyramidal symptoms may be less frequent than with older antipsychotics. the atypical antipsychotics should be considered when choosing first-line treatment of newly diagnosed schizophrenia. an atypical antipsychotic is considered the treatment option of choice for managing an acute schizophrenic episode when discussion with the individual is not possible. an atypical antipsychotic should be considered for an individual who is suffering unacceptable side-effects from a conventional antipsychotic. an atypical antipsychotic should be considered for an individual in relapse whose symptoms were previously inadequately controlled. changing to an atypical antipsychotic is not necessary if a conventional antipsychotic controls symptoms adequately and the individual does not suffer unacceptable side-effects.

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Drugs used in Psychosis and related disorders


When prescribing an antipsychotic for administration on an emergency basis, the intramuscular dose should be lower than the corresponding oral dose (owing to absence of first-pass effect), particularly if the patient is very active (increased blood flow to muscle considerably increases the rate of absorption). The prescription should specify the dose for each route and should not imply that the same dose can be given by mouth or by intramuscular injection. The dose of antipsychotic for emergency use should be reviewed at least daily.

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Hypnotics and anxiolytics


Most anxiolytics (sedatives) will induce sleep when given at night and most hypnotics will sedate when given during the day. Prescribing of these drugs is widespread but dependence (both physical and psychological) and tolerance occurs. This may lead to difficulty in withdrawing the drug after the patient has been taking it regularly for more than a few weeks. Hypnotics and anxiolytics should, therefore, be reserved for short courses to alleviate acute conditions after causal factors have been established. Benzodiazepines are the most commonly used anxiolytics and hypnotics; they act at benzodiazepine receptors which are associated with gamma-aminobutyric acid (GABA) receptors. Older drugs such as meprobamate and barbiturates are not recommended—they have more side-effects and interactions than benzodiazepines and are much more dangerous in overdosage.

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