Symptoms of feeling dizzy. 7 Common Causes of Dizziness: Symptoms, Treatments, and Prevention
What are the main causes of dizziness. How can you identify different types of dizziness. What treatments are available for various forms of dizziness. When should you seek medical attention for dizziness symptoms.
Understanding Vertigo: The Spinning Sensation
Vertigo is a specific type of dizziness characterized by a sensation of spinning or the environment moving around you. It’s often more intense than general dizziness and typically worsens with head movements. Vertigo stems from issues in the inner ear or parts of the brainstem responsible for balance.
The most common form of vertigo is benign paroxysmal positional vertigo (BPPV). This condition occurs when tiny calcium particles in the inner ear become dislodged and move into areas where they don’t belong, causing confusion in the balance system.
What causes BPPV?
- Natural age-related cell breakdown
- Head injuries
BPPV symptoms are typically brief and triggered by specific head movements, such as tilting, turning, or rolling over in bed. While often resolving on its own, BPPV can be treated effectively with specialized head exercises known as the Epley maneuver, which aims to reposition the displaced calcium particles.
Other causes of vertigo:
- Meniere’s disease
- Labyrinthitis
- Acoustic neuroma (a type of tumor)
- Vestibular migraine
- Multiple sclerosis
- Stroke affecting the cerebellum
Ear Infections and Inflammation: A Common Culprit
Inflammation of the nerves in your ears can lead to vertigo and dizziness. Two primary conditions in this category are vestibular neuritis and labyrinthitis. Both are typically caused by infections, with viruses being the most common culprits. However, bacteria from middle ear infections or meningitis can also spread to the inner ear.
How do vestibular neuritis and labyrinthitis differ?
Vestibular neuritis involves inflammation of the vestibular nerve only, while labyrinthitis affects both the vestibular and cochlear nerves. This distinction can impact the range of symptoms experienced.
Common symptoms of ear-related dizziness:
- Sudden onset of dizziness
- Tinnitus (ringing in the ears)
- Hearing difficulties
- Nausea
- Fever
- Ear pain
These symptoms can persist for several weeks. Treatment depends on the underlying cause. Viral infections can’t be treated with antibiotics, but medications can help manage symptoms while the infection runs its course.
Meniere’s Disease: A Complex Inner Ear Disorder
Meniere’s disease is a chronic condition characterized by episodes of severe vertigo that can last for hours. It’s associated with an abnormal buildup of fluid in the inner ear, though the exact cause remains unknown.
What are the hallmark symptoms of Meniere’s disease?
- Intense vertigo episodes
- Feeling of fullness or pressure in one ear
- Tinnitus (ringing in the ears)
- Fluctuating hearing loss
- Nausea
- Fatigue following an attack
While there’s no cure for Meniere’s disease, treatment focuses on managing symptoms and reducing the frequency of attacks. This often involves dietary changes, particularly adopting a low-salt diet, and medications to control dizziness.
Circulation Issues: When Blood Flow Falters
Dizziness can be a sign of problems with blood flow to the brain. Your brain requires a constant supply of oxygen-rich blood to function properly. When this supply is compromised, it can lead to lightheadedness and even fainting.
What circulatory issues can cause dizziness?
- Blood clots
- Atherosclerosis (clogged arteries)
- Heart failure
- Arrhythmias (irregular heartbeats)
- Orthostatic hypotension (sudden drop in blood pressure upon standing, common in older adults)
If you experience dizziness accompanied by fainting or loss of consciousness, it’s crucial to seek immediate medical attention. These symptoms could indicate a serious underlying condition requiring prompt treatment.
Medication-Induced Dizziness: An Overlooked Cause
Many medications list dizziness as a potential side effect. If you’re experiencing unexplained dizziness, it’s worth reviewing your current medications with your healthcare provider.
Which types of medications commonly cause dizziness?
- Antibiotics (e.g., gentamicin, streptomycin)
- Antidepressants
- Anti-seizure medications
- Blood pressure medications
- Sedatives
Never stop taking prescribed medications without consulting your doctor. If dizziness is severely impacting your quality of life, your healthcare provider may be able to adjust your dosage or suggest alternative treatments.
Dehydration: A Simple Yet Serious Cause of Dizziness
Dehydration occurs when your body loses more fluids than it takes in. This imbalance can lead to a decrease in blood volume, potentially causing dizziness and other symptoms.
Who is at higher risk for dehydration-related dizziness?
- Older adults
- People with diabetes
- Those living in hot climates or at high altitudes
- Athletes and people who exercise intensively
Severe dehydration can cause a drop in blood pressure, reducing oxygen flow to the brain and resulting in dizziness. It’s essential to maintain proper hydration, especially in hot weather or during physical activity.
How can you prevent dehydration-related dizziness?
- Drink water regularly throughout the day
- Consume hydrating foods (e.g., fruits, vegetables)
- Monitor your urine color (pale yellow indicates good hydration)
- Limit alcohol and caffeine intake, as these can contribute to dehydration
Low Blood Sugar: A Hidden Trigger for Dizziness
Hypoglycemia, or low blood sugar, can cause dizziness along with other symptoms. While it’s most common in people with diabetes, particularly those taking insulin or certain diabetes medications, it can occur in anyone.
What are the signs of low blood sugar?
- Dizziness or lightheadedness
- Confusion
- Shakiness
- Sweating
- Hunger
- Irritability
- Blurred vision
If you suspect low blood sugar is causing your dizziness, consuming a quick source of glucose (such as fruit juice or glucose tablets) can help alleviate symptoms. However, it’s important to work with your healthcare provider to identify the underlying cause and develop a management plan.
When to Seek Medical Attention for Dizziness
While occasional mild dizziness may not be cause for concern, certain symptoms warrant immediate medical attention. It’s crucial to recognize these red flags to ensure prompt treatment of potentially serious conditions.
When should you seek emergency care for dizziness?
Seek immediate medical attention if your dizziness is accompanied by any of the following:
- Fainting or loss of consciousness
- Chest pain
- Severe or unusual headache
- Head injury
- High fever
- Irregular heartbeat
- Seizures
- Shortness of breath
- Stiff neck
- Sudden changes in speech, vision, or hearing
- Persistent vomiting
- Weakness or numbness in the face
- Weakness in a leg or arm
These symptoms could indicate serious underlying conditions such as stroke, heart problems, or neurological disorders that require immediate evaluation and treatment.
How do doctors diagnose the cause of dizziness?
Diagnosing the root cause of dizziness often involves a comprehensive approach:
- Detailed medical history
- Physical examination, including neurological and balance tests
- Blood tests to check for infections, anemia, or metabolic imbalances
- Imaging studies (e.g., CT scan, MRI) if a neurological cause is suspected
- Specialized tests such as electronystagmography (ENG) or videonystagmography (VNG) to evaluate inner ear function
Your healthcare provider will consider all your symptoms and overall health to determine the most appropriate diagnostic approach and treatment plan.
Lifestyle Modifications to Manage Dizziness
While medical treatment is often necessary for underlying causes of dizziness, certain lifestyle changes can help manage symptoms and reduce the frequency of dizzy spells.
What lifestyle changes can help alleviate dizziness?
- Stay hydrated by drinking plenty of water throughout the day
- Maintain a balanced diet rich in vitamins and minerals
- Get regular exercise to improve circulation and balance
- Practice stress-reduction techniques like meditation or deep breathing
- Ensure adequate sleep and maintain a consistent sleep schedule
- Avoid triggers such as sudden movements or certain visual stimuli
- Use assistive devices (e.g., a cane or walker) if balance is significantly affected
It’s important to work with your healthcare provider to develop a comprehensive management plan that addresses both the underlying cause of your dizziness and strategies to minimize its impact on your daily life.
Can vestibular rehabilitation therapy help with chronic dizziness?
Vestibular rehabilitation therapy (VRT) is a specialized form of physical therapy that can be highly effective for certain types of dizziness, particularly those related to inner ear disorders. VRT aims to:
- Improve balance and reduce fall risk
- Decrease dizziness and vertigo symptoms
- Enhance stability during movement
- Improve overall function and quality of life
A trained vestibular therapist can develop a personalized program of exercises and techniques tailored to your specific condition and symptoms. VRT has shown significant benefits for many individuals suffering from chronic dizziness, helping them regain confidence in their daily activities.
The Psychological Impact of Chronic Dizziness
Living with recurring or persistent dizziness can have a significant impact on mental health and overall well-being. Many individuals with chronic dizziness experience anxiety, depression, and a decreased quality of life.
How does chronic dizziness affect mental health?
- Increased anxiety, especially in situations that may trigger dizziness
- Development of avoidance behaviors
- Feelings of frustration and helplessness
- Social isolation due to fear of dizzy spells in public
- Decreased confidence in performing daily activities
- Sleep disturbances
It’s crucial to address both the physical and psychological aspects of chronic dizziness. Mental health support, such as cognitive-behavioral therapy or support groups, can be valuable components of a comprehensive treatment plan.
What coping strategies can help manage the emotional toll of dizziness?
- Practice mindfulness and relaxation techniques
- Engage in gentle exercise or yoga to improve overall well-being
- Maintain social connections and communicate openly about your experiences
- Set realistic goals and celebrate small achievements
- Educate friends and family about your condition to foster understanding and support
- Consider joining a support group for individuals with similar experiences
Remember that seeking help for the emotional aspects of chronic dizziness is just as important as addressing the physical symptoms. A holistic approach to treatment can significantly improve overall quality of life.
Emerging Research and Future Treatments for Dizziness
The field of vestibular research is constantly evolving, with new insights into the causes of dizziness and innovative treatment approaches on the horizon. Understanding these developments can provide hope and perspective for those living with chronic dizziness.
What are some promising areas of research in dizziness treatment?
- Gene therapy for inherited vestibular disorders
- Advanced imaging techniques for more precise diagnosis
- Vestibular implants to restore balance function
- Targeted drug delivery systems for inner ear conditions
- Virtual reality-based rehabilitation programs
- Neuromodulation techniques to regulate vestibular system function
While many of these approaches are still in experimental stages, they offer exciting possibilities for more effective and personalized treatments in the future.
How can patients stay informed about new developments in dizziness treatment?
- Follow reputable medical news sources and organizations focused on vestibular disorders
- Discuss emerging treatments with your healthcare provider during regular check-ups
- Consider participating in clinical trials if appropriate for your condition
- Attend educational seminars or webinars hosted by vestibular experts
- Join patient advocacy groups that provide updates on research and treatment advancements
Staying informed about the latest research can empower you to make educated decisions about your care and provide hope for improved management of dizziness symptoms in the future.
Why Am I Dizzy? 7 Possible Causes of Dizziness and How To Treat It
Written by Stephanie Langmaid
- Is It Vertigo?
- Is It an Infection?
- Is It Meniere’s Disease?
- Is It Your Circulation?
- Is It Your Medication?
- Is It Dehydration?
- Is It Low Blood Sugar?
- Is It Something Else?
- More
Many parts of your body — including your eyes, brain, inner ear, and nerves in your feet and spine — work together to keep you balanced. When a part of that system is off, you can feel dizzy. It can be a sign of something serious, and it can be dangerous if it makes you fall.
Your doctor will look at all your symptoms and overall health to figure out what’s going on and how to treat it.
Get medical attention immediately if you’re dizzy and you faint, fall, or can’t walk or have any of the following:
- Chest pain
- Different or really bad headache
- Head injury
- High fever
- Irregular heart rate
- Seizures
- Shortness of breath
- Stiff neck
- Sudden change in speech, vision, or hearing
- Vomiting
- Weakness or numbness in your face
- Weakness in your leg or arm
Does it feel like you’re spinning or the room is moving around you? That’s a classic sign of a particular type of dizziness called vertigo. It’s more than feeling off-kilter and usually gets worse when you move your head. This is a symptom that there is an issue in the inner ear or part of the brainstem governing balance. The most common kind is benign paroxysmal positional vertigo, or BPPV.
Your inner ear is a complicated system of canals filled with fluid. These let your brain know how your head is moving. With BPPV, tiny bits of calcium in part of your inner ear get loose and move to places they don’t belong. The system doesn’t work the way it should and sends your brain the wrong signals.
It’s often caused by the natural breakdown of cells that happens with age. A head injury can cause it, too.
You’ll feel it briefly when you tilt or turn your head, and especially when you roll over in bed or sit up. BPPV isn’t serious and usually goes away on its own. If not — or you’d like to help it along — it can be treated with special head exercises (“particle repositioning exercises”) called the Epley maneuver to get the pieces of calcium back in place. Most people feel better after one to three treatments.
There are other causes of vertigo both in and outside the brain. You can have Meniere disease (described below), labyrinthitis (described below), a tumor called an acoustic neuroma or side effects from some antibiotics. In the brain, it can be caused by a vestibular migraine, multiple sclerosis, malformations of brain structures or a stroke from lack of blood flow or bleed (hemorrhage) in the cerebellum.
Inflammation of the nerves in your ears also can cause vertigo. It can be either vestibular neuritis or labyrinthitis. Vestibular neuritis refers to inflammation of your vestibular nerve only while labyrinthitis involved both your vestibular nerve and your cochlear nerve. Both conditions are caused by an infection. Usually, a virus is to blame. But bacteria from a middle ear infection or meningitis can make their way into your inner ear as well.
In this case, dizziness usually comes on suddenly. Your ears may ring, and it may be hard to hear. You also may be nauseated and have a fever and ear pain. Symptoms can last several weeks.
If it’s caused by a virus and can’t be treated with antibiotics, medication can help make you feel better as the infection runs its course.
This condition brings on intense periods of vertigo that can last hours. You may feel fullness or pressure in one ear. Other symptoms include ringing in your ears, hearing loss, and nausea. You may feel exhausted after the attack passes.
People with Meniere’s disease have too much fluid in their inner ear. Doctors don’t know what causes it, and there’s no cure for it. It’s usually treated with diet changes (a low-salt diet) and medicine to control the dizziness.
Dizziness can be a sign of a problem with your blood flow. Your brain needs a steady supply of oxygen-rich blood. Otherwise, you can become lightheaded and even faint.
Some causes of low blood flow to the brain include blood clots, clogged arteries, heart failure, and an irregular heartbeat. For many older people, standing suddenly can cause a sharp drop in blood pressure.
It’s important to get medical help immediately if you’re dizzy and faint or lose consciousness.
Several drugs list dizziness as a possible side effect. Check with your doctor if you take:
- Antibiotics, including gentamicin and streptomycin
- Anti-depressants
- Anti-seizure medications
- Blood pressure medicine
- Sedatives
Many people don’t drink enough fluids to replace the liquid they lose every day when they sweat, breathe, and pee. It’s particularly a problem for older people and people with diabetes.
When you’re severely dehydrated, your blood pressure can drop, your brain may not get enough oxygen, and you’ll feel dizzy. Other symptoms of dehydration include thirstiness, tiredness, and dark urine.
To help with dehydration, drink plenty of water or diluted fruit juice, and limit coffee, tea, and soda.
People with diabetes need to check the amount of sugar (glucose) in their blood often. You can get dizzy if it drops too low. That also can cause hunger, shakiness, sweating, and confusion. Some people without diabetes also have trouble with low blood sugar, but that’s rare.
A quick fix is to eat or drink something with sugar, like juice or a hard candy.
Dizziness can be a sign of many other illnesses, including:
- Migraines, even if you don’t feel pain
- Stress or anxiety
- Nervous-system problems like peripheral neuropathy and multiple sclerosis
- Tumor in the brain or inner ear
You may have other symptoms besides dizziness with any of these conditions. If your dizziness won’t go away or impacts your ability to function, make sure to discuss it with your doctor to find out the cause and treat it.
Top Picks
Why Am I Dizzy? 7 Possible Causes of Dizziness and How To Treat It
Written by Stephanie Langmaid
- Is It Vertigo?
- Is It an Infection?
- Is It Meniere’s Disease?
- Is It Your Circulation?
- Is It Your Medication?
- Is It Dehydration?
- Is It Low Blood Sugar?
- Is It Something Else?
- More
Many parts of your body — including your eyes, brain, inner ear, and nerves in your feet and spine — work together to keep you balanced. When a part of that system is off, you can feel dizzy. It can be a sign of something serious, and it can be dangerous if it makes you fall.
Your doctor will look at all your symptoms and overall health to figure out what’s going on and how to treat it.
Get medical attention immediately if you’re dizzy and you faint, fall, or can’t walk or have any of the following:
- Chest pain
- Different or really bad headache
- Head injury
- High fever
- Irregular heart rate
- Seizures
- Shortness of breath
- Stiff neck
- Sudden change in speech, vision, or hearing
- Vomiting
- Weakness or numbness in your face
- Weakness in your leg or arm
Does it feel like you’re spinning or the room is moving around you? That’s a classic sign of a particular type of dizziness called vertigo. It’s more than feeling off-kilter and usually gets worse when you move your head. This is a symptom that there is an issue in the inner ear or part of the brainstem governing balance. The most common kind is benign paroxysmal positional vertigo, or BPPV.
Your inner ear is a complicated system of canals filled with fluid. These let your brain know how your head is moving. With BPPV, tiny bits of calcium in part of your inner ear get loose and move to places they don’t belong. The system doesn’t work the way it should and sends your brain the wrong signals.
It’s often caused by the natural breakdown of cells that happens with age. A head injury can cause it, too.
You’ll feel it briefly when you tilt or turn your head, and especially when you roll over in bed or sit up. BPPV isn’t serious and usually goes away on its own. If not — or you’d like to help it along — it can be treated with special head exercises (“particle repositioning exercises”) called the Epley maneuver to get the pieces of calcium back in place. Most people feel better after one to three treatments.
There are other causes of vertigo both in and outside the brain. You can have Meniere disease (described below), labyrinthitis (described below), a tumor called an acoustic neuroma or side effects from some antibiotics. In the brain, it can be caused by a vestibular migraine, multiple sclerosis, malformations of brain structures or a stroke from lack of blood flow or bleed (hemorrhage) in the cerebellum.
Inflammation of the nerves in your ears also can cause vertigo. It can be either vestibular neuritis or labyrinthitis. Vestibular neuritis refers to inflammation of your vestibular nerve only while labyrinthitis involved both your vestibular nerve and your cochlear nerve. Both conditions are caused by an infection. Usually, a virus is to blame. But bacteria from a middle ear infection or meningitis can make their way into your inner ear as well.
In this case, dizziness usually comes on suddenly. Your ears may ring, and it may be hard to hear. You also may be nauseated and have a fever and ear pain. Symptoms can last several weeks.
If it’s caused by a virus and can’t be treated with antibiotics, medication can help make you feel better as the infection runs its course.
This condition brings on intense periods of vertigo that can last hours. You may feel fullness or pressure in one ear. Other symptoms include ringing in your ears, hearing loss, and nausea. You may feel exhausted after the attack passes.
People with Meniere’s disease have too much fluid in their inner ear. Doctors don’t know what causes it, and there’s no cure for it. It’s usually treated with diet changes (a low-salt diet) and medicine to control the dizziness.
Dizziness can be a sign of a problem with your blood flow. Your brain needs a steady supply of oxygen-rich blood. Otherwise, you can become lightheaded and even faint.
Some causes of low blood flow to the brain include blood clots, clogged arteries, heart failure, and an irregular heartbeat. For many older people, standing suddenly can cause a sharp drop in blood pressure.
It’s important to get medical help immediately if you’re dizzy and faint or lose consciousness.
Several drugs list dizziness as a possible side effect. Check with your doctor if you take:
- Antibiotics, including gentamicin and streptomycin
- Anti-depressants
- Anti-seizure medications
- Blood pressure medicine
- Sedatives
Many people don’t drink enough fluids to replace the liquid they lose every day when they sweat, breathe, and pee. It’s particularly a problem for older people and people with diabetes.
When you’re severely dehydrated, your blood pressure can drop, your brain may not get enough oxygen, and you’ll feel dizzy. Other symptoms of dehydration include thirstiness, tiredness, and dark urine.
To help with dehydration, drink plenty of water or diluted fruit juice, and limit coffee, tea, and soda.
People with diabetes need to check the amount of sugar (glucose) in their blood often. You can get dizzy if it drops too low. That also can cause hunger, shakiness, sweating, and confusion. Some people without diabetes also have trouble with low blood sugar, but that’s rare.
A quick fix is to eat or drink something with sugar, like juice or a hard candy.
Dizziness can be a sign of many other illnesses, including:
- Migraines, even if you don’t feel pain
- Stress or anxiety
- Nervous-system problems like peripheral neuropathy and multiple sclerosis
- Tumor in the brain or inner ear
You may have other symptoms besides dizziness with any of these conditions. If your dizziness won’t go away or impacts your ability to function, make sure to discuss it with your doctor to find out the cause and treat it.
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Dizziness: types, description, symptoms – medical center “YOUR DOCTOR” Shakhty
Therapy
Dizziness is a pretty serious symptom. Therefore, with the appearance of frequent dizziness, you should visit a doctor, especially you need to hurry if this symptom appears without a specific apparent reason. Frequent unpleasant dizziness can be accompanied by nausea, weakness, and in some cases vomiting. There are many reasons for these symptoms. At the same time, doctors diagnose false and true dizziness.
True dizziness is diagnosed in disorders of the vestibular apparatus. This is a complex pathology that is difficult to treat. Most often, false dizziness is diagnosed, in which additional symptoms are observed: a sharp darkening in the eyes (most often due to a sharp change in the static position of the body), sweating, weakness, the appearance of a veil before the eyes, loss of balance, etc. Such symptoms are quite easy to eliminate. When they appear, you should drink warm water with sugar dissolved in it (about three tablespoons per glass of plain water).
Due to physiological changes in the body, dizziness can occur in older people. But if the symptoms have become systematic and if other alarming symptoms have appeared, then the visit to the doctor should not be postponed.
Dizziness may be disturbing in iron deficiency anemia. When diagnosing anemia, in addition to feeling dizzy, one feels malaise, weakness, lack of appetite, and a decrease in working capacity is observed.
Frequent migraines may also be accompanied by dizziness. Therefore, it is necessary to cure migraine in order to get rid of unpleasant symptoms.
During pregnancy, menopause and menstruation, hormonal changes take place, which can also cause dizziness. In addition, during menstruation, a woman loses hemoglobin, which leads to anemia. With this disease, oxygen starvation of the brain passes, and as a result, dizziness appears.
During menopause, some women experience jumps in blood pressure, which leads to autonomic disorders. It is also accompanied by dizziness.
False dizziness can occur in anxiety and stress conditions. Phobias and the presence of an unstable psyche become the causes of dull pains, sweating, heart palpitations and confusion. To cure dizziness, it is enough to remove the cause of anxiety.
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Dizziness and weakness of the cause – Treatment of dizziness in ON CLINIC Ryazan, price
The essence of such a pathology as dizziness (vertigo) can be described as follows – the orientation of the patient’s body in space is disturbed for some reason. The patient has the illusion that he or the objects around him are rotating. Feelings may resemble those that occur in a person with drug or alcohol intoxication. Often, dizziness and weakness are accompanied by lightheadedness and difficulty keeping the body upright.
As for the possible causes of dizziness, their number is slightly less than a hundred. Making a correct diagnosis can be complicated by the fact that the patient often has several of these causes. Some of them are not dangerous – overwork, “seasickness”, hunger, etc. But sometimes weakness, dizziness and nausea can indicate a patient has a serious illness.
Causes of dizziness
Here are just some of the factors that can lead to this unpleasant sensation in a person:
- otitis, or inflammation in the ear. Such a symptom as dizziness may be accompanied by discharge from the auditory canal, ear pain, hearing impairment, etc .;
- Meniere’s disease is accompanied by severe dizziness, as well as vomiting and tinnitus;
- such symptoms may indicate that the patient has anemia;
- severe dizziness, which lasts for a long time, often accompanies a stroke;
- one of the diseases affecting the vestibular apparatus – the corresponding type of neuritis – is characterized by severe and severe dizziness that occurs when the body’s position in space changes, the head turns, and also after acceleration – for example, getting up in an elevator;
- patients with osteochondrosis of the cervical spine are familiar with the accompanying attacks of weakness, dizziness and nausea. These symptoms may be accompanied by pain in the neck and uncertainty of the patient’s gait;
- all kinds of neoplasms in the brain can be manifested by bouts of dizziness, which gradually increase and tend to manifest themselves when the patient assumes a certain position of the body. In addition, the patient may temporarily stop hearing with the right or left ear, and also complain of a severe headache;
- Most traumatic brain injuries are accompanied by dizziness and nausea;
- Finally, vertigo can be one of the side effects that occur after taking certain pharmaceuticals. Some broad-spectrum antibiotics, sedatives, antihypertensives, and drugs for the treatment of cardiovascular diseases can lead to the development of this pathology. In order to get rid of this unpleasant symptom, it is usually enough to reduce the dose of the drug or completely stop taking it. In any case, the final decision is made by the attending physician.
In addition, for a woman, weakness, dizziness and nausea are an occasion to urgently take a pregnancy test.