Piracetam in patients with chronic vertigo - Results of a double-blind, placebo-controlled study

The nootropic agent piracetam, which exerts diverse effects through actions on cerebral neurotransmission, has been reported to alleviate vertigo. We performed a multicentre, double-blind, placebo-controlled study to assess the efficacy and tolerability of piracetam 800mg 3 times daily orally for 8 weeks. The study group consisted of 143 middle-aged and elderly outpatients of ear, nose and throat clinics who had suffered from vertigo for at least 3 months, had experienced at least 3 episodes per month, and the vertigo was severe enough to disrupt daily life. Primary outcome measures were patient self-evaluations of vertigo: the frequency of episodes, and their severity using visual analogue scales (VAS). Malaise and imbalance between episodes (VAS), the effect of vertigo on walking (VAS), the duration of incapacity, and overall evaluations by patients and investigators were also assessed. On entry, episodes were more frequent (p < 0.05) and malaise between episodes more severe (p < 0.05) in the piracetam group. Data were not evaluable in 54 patients because of either adverse events (12 piracetam, 12 placebo) or protocol deviations. An intention-to-treat analysis showed that episodes of vertigo were less frequent (p < 0.03) but not less severe on piracetam than on placebo: interval malaise (p < 0.05) and imbalance (p < 0.01) improved more and the duration of incapacity was less (p < 0.05). These changes, which were maximal after 8 weeks' medication, had almost disappeared 4 weeks after the end of treatment. Tolerance to piracetam was good, with few drug-related adverse events occurring. These findings provide further evidence that piracetam alleviates vertigo by reducing the frequency of episodes, the severity of malaise and imbalance between episodes, and the duration of associated incapacity.