To our knowledge, there is no systematic review on painkiller-related dizziness, which often occurs.
Papers from core clinical journals on PubMed-database resulted in 340 articles on dizziness in malignant tumors until 31st Dec 2017. Eight studies with level of evidence (LoE) 1 focused on dizziness as a side effect of painkillers.
In a meta-analysis on codeine, dizziness was reported in 18.06 % of patients (LoE 1a) . In randomized controlled trials (LoE 1b), oxycodone-associated dizziness was only seen in controlled release (8.3 %) and not in immediate release oxycodone . In a systematic review (LoE 1a) , controlled release oxycodone was associated with 11.9 % of dizziness reports. A meta-analysis on immediate release morphine and transmucosal fentanyl (7 % dizziness) favoured transmucosal fentanyl for breakthrough cancer pain, but did not differentiate between the painkillers for dizziness . Effective analgesia with rare (1.8 to 7.5 %) events of dizziness was reported for intranasal fentanyl spray (LoE 1b) . For long-acting analgesia, a systematic review favoured transdermal fentanyl over sustained release oral morphine (LoE 1a) . A randomized controlled trial in bone metastases favoured the combination of two nonsteroidal anti-inflammatory drugs (NSAIDs) plus morphine (10.3 % dizziness reports) over one NSAID plus morphine (> 25 %), presumably due to lower morphine need in two NSAIDs (LoE 1b) . Finally, both hydromorphone and morphine had at least 15 % of dizziness reports in a systematic review (LoE 1a) .
There is level of evidence 1a to 1b that immediate release oxycodone, transmucosal or intranasal fentanyl are associated with the lowest incidence of dizziness. For long-acting analgesia, transdermal fentanyl is a promising option. References: 1. Straube C, et al. Cochrane Database Syst Rev. 2014;9:CD006601. 2. Salzman RT, et al. J Pain Symptom Manage. 1999;18:271-9. 3. Ma H, et al. Medicine (Baltimore). 2016;95:e3341. 4. Coluzzi PH, et al. Pain. 2001;91:123-30. 5. Kress HG, et al. Clin Ther. 2009;31:1177-91. 6. Yang Q, et al. J Exp Clin Cancer Res. 2010;29:67. 7. Liu Z, et al. Int J Clin Oncol. 2017;22:980-5. 8. Bao YJ, et al. Cochrane Database Syst Rev. 2016;10:CD011108. Equal contribution: S.R., R.S., R.K.
Clinical trial identification
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S.I. Rothschild: Honoraria for advisory boards to institution: Abbvie, AstraZeneca, Boehringer Ingelheim, BMS, Eisai, Eli Lilly, Merck, MSD, Novartis, Pfizer, Roche, Takeda; Research support: AstraZeneca, Boehringer Ingelheim, BMS, Eisai. R. Sutter: Research grants: Swiss National Foundation (No 320030_169379), Research Fund of the University of Basel, Scientific Society Basel, Gottfried Julia Bangerter-Rhyner Foundation; Personal grants: UCB-pharma, Destin Pharma GmbH; Stocks: Novartis, Roche. R. Kalla: Supported by the Swiss National Science Foundation (Grant #320030_173081). All other authors have declared no conflicts of interest.