Vertigo and salicylates

A neighbour said recently: “there’s an epidemic of vertigo happening here”.  There can be many causes of vertigo. Most people don’t realise that vertigo – or dizziness – can be related to drugs and foods.

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Key points

  • Vertigo can be a side effect of many drugs
  • Aspirin can be associated with reversible hearing loss, tinnitus (ringing in the ears), and vertigo
  • People who have problems with salicylates in drugs can also have problems with salicylates in foods

Many drugs

If you develop vertigo soon after starting a new prescription or over-the-counter drug, ask your pharmacist or doctor if vertigo is listed as a side effect. Or see this Consumer Report on drugs that can make you dizzy

Vertigo could also be related to salicylates in:

  • aspirin (methyl salicylate)
  • drugs that interact with aspirin – e.g. anti-inflammatories such as ibuprofen or nurofen, and many others
  • herbal medications such oil of wintergreen or white willow bark (see story below), and any medications containing salicylates or with a warning for asthmatics in the Consumer Medicine Information sheet. Salicylate containing skin creams or ointments can include arthritis creams, sports creams like Dencorub, Vicks Vaporub, teething gel and oral gels like Bonjela and Ora-Sed, wart removers, acne cleansers and some insect repellents.

“I’ve been using Ibuprofen regularly for my chronic back pain …  I switched to white willow bark and have had vertigo for 2 weeks. I stopped taking all my herbal medicines and the vertigo subsided but came back today after taking white willow bark and then a light bulb came on (when I saw your salicylates factsheet!)”  - Ramesh, UK, [1458]

Doctors don’t necessarily know

In Europe, the vertigo- salicylate effect seems well known (see French, German and Swiss papers below).  However, it seems that salicylates as a cause of vertigo are now commonly overlooked in English-speaking countries - as you can see in the list of vertigo-causing drugs above that doesn’t include aspirin.

The following story comes from a 48 year old now-failsafer  who had an allergic reaction to aspirin, developed vertigo while taking pasugrel (known to interact with aspirin), and later developed a life-threatening  reaction after eating large amounts of wild blackberry jam while taking anti-inflammatories.

“Later that day I found virtually all my arms and neck covered in hives and rashes, I had difficulty breathing and was taken to Accident & Emergency in an ambulance ...  My partner discovered that blackberries are very high in salicylates which is also the reason that people have an allergic reaction to aspirin. When I mentioned this at A&E they seemed totally unaware of this link, and carried on treating me for a suspected heart attack …Why was it not obvious to trained medical staff that if you have an allergic reaction to aspirin, it is quite likely that it is because of salicylates and that care should then be taken when prescribing further medicines?” – Tony, UK [1386]

If you are sensitive to salicylates in drugs, you may also be sensitive to salicylates in foods

Here are a mother and daughter who are both suffer from aspirin-induced vertigo and other salicylate-related health issues:

“My mother and I have known for years that we are allergic to aspirin. We both react with ringing in the ears, nausea, vertigo, lethargy, and I even lost consciousness once … My mother and I both have had doctors mystified for years with strange and debilitating health issues …  None of my doctors have ever mentioned that salicylates are in foods.

After coming across this information I realised that almost every diet change recommended to me by the doctors has caused my salicylate intake to be astronomical. It's no wonder I've been in and out of emergency rooms.

Everyone made fun of me calling me a "health nut" because of the supposedly ultra-healthy diet I was on … on a low salicylate diet my mother and I have both been improving so drastically that everyone is asking us what is going on.”  [559]

References

Our salicylate factsheet

Our tinnitus story collection

Cuffel C, Guyot JP. [Aspirin ototoxicity: a rare situation today]. [article in French] Rev Med Suisse. 2013;9(400):1785-8. From the abstract: We report a case of acute aspirin intoxication resulting in a transitory hearing loss, tinnitus, and vertigo. https://www.ncbi.nlm.nih.gov/pubmed/24187753

Fleck C, [Vertigo drug therapy--merely drug vertigo? Vertigo from the pharmacologic viewpoint]. [Article in German] Arztl Fortbild Qualitatssich, 2000;94(6):501-7. From the abstract: The variety of drugs responsible for vertigo consists in relatively harmless substances like aspirin up to substances used in vertigo drug therapy! https://www.ncbi.nlm.nih.gov/pubmed/10996941

Venna N, Dizziness, falling, and fainting: differential diagnosis in the aged (Part II), Geriatrics, 1986;41(7):31-3, 36-7, 41-5. From the abstract: Salicylates used for rheumatoid arthritis, or in inadvertently high dosages by patients themselves, often cause toxicity manifested by tinnitus, hearing impairment, and imbalance. Vestibulotoxic drugs should always be considered in older patients when the cause of imbalance is not apparent. https://www.ncbi.nlm.nih.gov/pubmed/3721202

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