EGB 761 for treatment of vertigo and tinnitus .pptx

EGB 761 for vertigo and tinnitus

1. Current Therapeutic Approach in Vertigo & Tinnitus TH-TEB-21-02-030

2. Vertigo An illusory sense of motion, with the patient feeling as if the motion were internal or that objects in the surroundings were moving or tilting. The sense of motion can be rotatory or linear, or it can represent a change in orientation relative to the vertical. Vertigo indicates a problem in the peripheral or central vestibular system.

3. Vertigo Vestibular Non-Vestibular Common term Spinning, tilting, motion sickness Lightheaded, floating, swimming Course Episodic Constant Precipitating factor Head movement, Position change Stress, cardiac arrhythmia, hyperventilation Associated symptom N/V, unsteadiness, tinnitus, hearing loss, oscillopsia* Perspiration, pallor, palpitation, syncope

4. Vestibular Peripheral Central N&V Severe Moderate Imbalance Mild Severe Hearing loss Common Rare Oscillopsia Mild Severe Neurologic symptom Rare Common Compensation Rapid Slow

5. https://link.springer.com/article/10.1007/s00415-015-7973-3/figures/1

6. Vestibular disorders Durationr HL Tinnitus BPPV Seconds +/- +/- Meniere’s disease Min - Hrs + + Vestibular neuritis Days - -

7. Management of Vertigo/Dizziness Vestibular rehabilitation - Adaptation exercises - Liberatory and reposition maneuvers Psychotherapeutic measures & support Pharmacotherapy Transtympanic injection Surgical treatments Prevention

8. Pharmacotherapy 1. Specific targeting the underlying cause (e.g, ear infection, syphilis) 2. Symptomatic controlling the acute symptoms and autonomic complaints (e.g, vertigo and vomiting) 3. Prophylactic aims to reduce the recurrence of specific vertiginous conditions, as in MD, VM or vestibular paroxysmia

9. Symptomatic treatment Antivertigenosa for AVS in 1st 3 days *** A) Vestibular suppressants (sedatives) 1) AntiH1 - dimenhydrinate (50mg q 4-6hr, 150 mg suppo 1-2/day) 2) AntiACh - TD Scopolamine 1mg over 72 hrs 3) BZP - diazepam (5-10mg q 4-6hr, 10 mg i.m.), or clonazepam (0.5mg q 4-6hr) B) Improvement of central vestibular compensation e.gs betahistine, EGb 761

10. Tinnitus The perceived sensation of sound in the absence of a corresponding external acoustic stimulus. Buzzing, hissing, or ringing. Unilateral or bilateral Intermittent or pulsatile character.

11. M anagement

12. Antidepressants (TCA, trazodone, and SSRI) SE : serual dysfunction, drowsiness, dry mouth, and rarely tinnitus itself Anticonvulsants SE : nausea, dizziness, headaches Intratympanic medication SE : vertigo, nausea, vomiting, otalgia Gabapentin Acamprosate a gamma-aminobutyric acid (GABA) and glutamate-mediated neurotransmitter

13. Zinc : No benefit Ginkgo biloba No clearly defined benefit Melatonin May improve insomnia with tinnitus, evidence limited Vitamins and supplements (Multivitamin, coenzyme Q, herbal remedies) No strong evidence to support

14. Mode of Action of EGb 761 ® EGb 761 ® the unique active ingredient, shows a multifactorial mode of action: Ref: Basta D. 2017, Med. Welt 68, (1), 46-52

15. EGb 761® study in the vertigo treatment EGb 761® systematic review EGb 761® vs. current therapy in vertigo treatment in vestibular compensation Dizziness in demented patients

16. EGb 761® reduces the intensity, frequency and duration of vertigo attacks EGb 761® is as effective as betahistine in the treatment of vertigo, but EGb761® is better tolerated EGb 761® improve vestibular compensation EGb 761 ® reduces dizziness in AD & VAD

17. EGb 761® reduces the intensity, frequency and duration of vertigo attacks EGb 761® is as effective as betahistine in the treatment of vertigo, but EGb761® is better tolerated EGb 761® improve vestibular compensation EGb 761 ® reduces dizziness in AD & VAD EGb 761® 240 mg daily (120 mg BID) VS. betahistine dihydrochloride 32 mg daily (16 mg BID)

18. EGb 761® studies in the tinnitus treatment 1.1 EGb 761® systematic review 1.2 The duration of acute tinnitus in EGb 761® treatment 1.3 The perceived severity of tinnitus in EGb 761® treatment 1.4 EGb 761® vs. current therapy in efficacy & response rate in tinnitus in chronic tinnitus

19. Ref: von Boetticher. Neuropsychiatric Disease and Treatment 2011:7 441– 447 EGb 761® in the treatment of tinnitus: a systematic review

20. Ref: von Boetticher. Neuropsychiatric Disease and Treatment 2011:7 441– 447 EGb 761® in the treatment of tinnitus: a systematic review In all studies included, EGb 761® was superior to placebo for the treatment of tinnitus patients This statement is as well valid for treatment of patients with tinnitus as primary complaint, also for patients who developed tinnitus subsequent to cognitive impairment

21. EGb 761® is clinically proven … EGb 761® was superior to placebo for the treatment of tinnitus patients EGb 761® reduces the duration of acute tinnitus EGb 761® reduces the perceived severity of tinnitus EGb 761® shows stronger response rates than specific synthetic drugs EGb 761 ® improves or even resolve symptoms of tinnitus EGb 761® reduces the suffering of patients with sub-chronic or chronic tinnitus Conclusions

22. Cerebral circulatory insufficiency. Disturbances of cerebral performance due to cerebral circulatory insufficiency. Peripheral circulatory disorders. Tinnitus (ringing in the ears) and vertigo (dizziness). Peripheral arterial occlusive disease (PAOD). Relief of symptoms of mild or moderate dementia and mixed form. Symptomatic treatment of mild cognitive impairment(MCI) Indications

23. The normal dosage is 1 tablet of Tebonin forte 120mg daily. For more intensive use, 1 tablet may be taken twice daily (240 mg per day). The intake of Tebonin forte 120mg is independent of meals. For the indication of mild cognitive impairment (MCI) , 2 tablets may be taken once daily (240mg per day) Dosage

24. Contra-indications: Known hypersensitivity to Ginkgo extracts or to any of the excipients. Special warnings and Precautions for use: children and adolescents under the age of 18 years bleeding tendency epileptic patients Patients with rare hereditary galactose intolerance, lactase deficiency or glucose-galactose malabsorption Contrai ndications

25. Fertility, Pregnancy and Lactation: no or limited amount of data Adverse reactions :single reports from patients, physicians or pharmacists. Gastrointestinal disorders: Mild gastrointestinal disturbances. Skin and subcutaneous tissue disorders / Immune system disorders: Hypersensitivity reactions (reddening,swelling, itching). Nervous system disorders: Headache. Vascular disorders: Bleeding from single organs has been reported. Drug interactions : Specific clinical studies did not show any potentiation of the blood thinning effect of warfarin and aspirin. However, interactions with coagulation inhibiting drugs cannot be completely excluded. Adverse reactions

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