Inappropriate antivertiginous drug prescribing for patients with vestibular symptoms in primary care

Context: There is insufficient evidence that antivertiginous drugs are effective in patients with vestibular symptoms. However, betahistine is one of the most frequently prescribed off-label drugs. The role of family physicians in these inappropriate drug prescriptions is still unclear.

Objective: This study aimed to evaluate the frequency of (long-term) antivertiginous drug prescriptions in primary care. We also aimed to identify factors associated with long-term prescriptions.

Study design and Analysis: We performed a retrospective observational cohort study. We used descriptive statistics to determine baseline characteristics and to calculate the prevalence and incidence of prescriptions. We performed a multivariable logistic regression analysis to identify factors associated with long-term prescriptions.

Setting: We used routine primary care data from more than 1.2 million patients registered at 269 primary care practices throughout the Netherlands within the period March 2018 to February 2021.

Population studied: We included adult patients with vestibular symptoms and/or prescriptions for antivertiginous drugs using International Classification for Primary Care (ICPC) codes and Anatomical Therapeutic Chemical codes.

Intervention/Instrument: Not applicable.

Outcome measures: Primary outcome was the prevalence of prescriptions for antivertiginous drugs. Secondary outcomes were the incidence of prescriptions, prevalence of long-term prescriptions, and factors associated with long-term prescriptions.

Results: We included 72.429 patients with vestibular ICPC codes, 9.2% of these patients had at least one prescription for antivertiginous drugs. 2.700 patients received prescriptions without a vestibular ICPC code. Of all patients with prescriptions, 36% received long-term prescriptions. Older age, Ménière’s disease, and practices with 7.501-10.000 registered patients were associated with a higher rate of longterm prescriptions, while patients with vestibular neuritis, benign paroxysmal positional vertigo and a symptom diagnosis of lightheadedness were less likely to receive one. Patients registered at practices in extremely urbanized areas were also less likely to receive long-term prescriptions.

Conclusions: Inappropriate antivertiginous drug prescriptions, including long-term prescriptions, are still common in Dutch primary care. Our findings indicate that management of patients with vestibular symptoms by family physicians can be further improved.