Diuretics May Impact BPPV Risk Based on Patient History and Drug Class, suggests study
Researchers have found in a new study that all diuretics can influence the risk of benign paroxysmal positional vertigo (BPPV), either positively or negatively, depending on a patient's medical history. These effects appear to be more associated with the overall efficacy of each diuretic class rather than their specific mechanisms of action.
This study aims to characterize diuretic use among patients with and without benign paroxysmal positional vertigo (BPPV) using a population-level database.Subjects with ≥1 hospital visit between 2019 and 2024 were queried and stratified by age (18-44, 45-64, and 65+ years) and sex. Each cohort was then divided into those with/without BPPV. Patients with head trauma, middle/inner ear surgery, central vertigo, or migraine were excluded.
The prevalence of diuretic use and vitamin D deficiency of each case cohort was compared against the control cohort of the same age/sex using Chi-square analysis. This stratification and analysis were repeated for patients with a vestibular disorder, as well as those with/without Ménière's disease (MD).
Results: Diuretic use was significantly more common in case cohorts than in control cohorts in the general population. In vestibular patients, thiazide and carbonic anhydrase inhibitor (CAI) use were more common in control cohorts, and loop use was less common. In MD patients, thiazide and loop use were more common in control cohorts, and CAI use did not differ significantly. In patients without MD, CAI use also did not differ, while thiazide and loop use were less common in control cohorts.
All diuretics may alter the risk of BPPV. Their influences can be favorable or unfavorable, depending on the individual patient's medical history. Their effects might relate more directly to the efficacy of each diuretic class rather than their specific mechanisms of action.
Reference:
Li, M., Chiffer, R.C. and Li, H. (2025), Risk of Benign Paroxysmal Positional Vertigo Modified by Diuretics—A Population-Level Case-Control Study. Otolaryngol Head Neck Surg. https://doi.org/10.1002/ohn.1282
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