Dizziness on treatment: steady habits and when to call

Dizziness can mean feeling off-balance, light-headed or faint, or feeling as if you or the room around you is spinning (vertigo). It is common, usually not serious and often passes on its own (NHS).

In the EU product information for these medicines, dizziness is listed among the common side effects. For some of them, low blood pressure is also listed. The product information for some of these medicines notes that dizziness can occur mainly while the dose is being increased (EMA product information).

Dizziness also has many causes that have nothing to do with treatment, for example an ear infection, migraine, stress or anxiety, or iron deficiency anaemia (NHS). A doctor can help find the cause if it keeps happening (AWMF guideline on dizziness).

Standing or sitting up suddenly can cause a short drop in blood pressure. This is called postural or orthostatic hypotension. Typical signs are dizziness, blurred vision and light-headedness shortly after getting up. Sitting or lying down usually eases them quickly (gesund.bund.de; NHS).

Not drinking enough can also make you dizzy. Signs of dehydration include thirst, dark yellow urine, peeing less often than usual, tiredness and a dry mouth (NHS). The EMA product information notes that nausea, vomiting and diarrhoea can lead to fluid loss, which in rare cases can affect kidney function. Drinking enough matters, especially when your stomach is upset (EMA product information).

When your appetite is quieter, long gaps without food can leave you feeling weak or shaky. Small, regular meals can help with symptoms of low blood pressure (NHS).

Low blood sugar (hypoglycaemia) is rare in people without diabetes. It mainly affects people who take certain diabetes medicines that lower blood sugar (NHS). Signs include feeling hungry, dizzy, shaky, sweaty, anxious or irritable, tired or weak, blurred vision, heart palpitations and confusion (NHS).

The EMA product information notes that the risk of low blood sugar can be higher when these treatments are combined with certain diabetes medicines, and that the dose of those medicines may need to be lowered (EMA product information). Tell us about all your diabetes medicines in the questionnaire. Follow the plan agreed with your diabetes doctor, and check your blood sugar if you have symptoms and are able to test. Do not change your diabetes medicines on your own.

Try not to skip or delay meals, and do not drink alcohol without eating (NHS).

Sit or lie down until the feeling passes, then get up slowly. Move slowly and carefully, rest and drink some water. Avoid coffee, alcohol and smoking while you feel dizzy (NHS).

If you feel as if you might faint, lie down with your legs raised. If you cannot, sit with your head lowered between your knees (NHS).

Do not drive, climb ladders or use machines while you feel dizzy (NHS). The EMA product information also advises caution with driving and using machines if dizziness occurs (EMA product information).

Get up in stages: from lying to sitting, then to standing, especially in the morning. Tensing and relaxing your calf muscles before you stand up can also help (gesund.bund.de; NHS).

Drink regularly through the day, ideally water or unsweetened tea (DGE). Drink more when you sweat, are somewhere hot or have an upset stomach (NHS). If you are being sick or have diarrhoea, small sips are often easier, and a pharmacy can advise you on oral rehydration solutions (NHS).

Avoid standing still for long periods and bending down suddenly, and go easy on alcohol (NHS). A short note of when dizziness happens, what you ate and drank beforehand and how long it lasted can help at your next review.

See your GP if dizziness keeps coming back or does not go away, if you have fainted, if you notice changes in your hearing or ringing in your ears, or if dizziness comes with headaches or feeling sick (NHS). Outside surgery hours in Germany, the medical on-call service is available on 116117 (116117.de). Your GP remains an important part of your care.

Contact your doctor if you feel dizzy when you stand up and it does not go away, have signs of dehydration, have persistent vomiting or diarrhoea, or cannot keep fluids down (NHS; EMA product information). If you have severe side effects, contact a doctor straight away, the out-of-hours service on 116117 or, in an emergency, 112.

Call 112 straight away if dizziness comes with sudden weakness or numbness in your face, arm or leg, slurred or confused speech, sudden loss of vision or a sudden severe headache. These can be signs of a stroke, even if they stop again (NHS; gesund.bund.de).

Also call 112 if someone has fainted and cannot be woken, has not fully recovered, has chest pain or a pounding or irregular heartbeat, is having a seizure, or fainted during exercise or while lying down (NHS). If a person with diabetes may have very low blood sugar and is not responding normally or is unconscious, call 112 and do not give them food or drink (NHS).

Keep your usual treatment day or time as described in the patient leaflet, and do not change, pause or double a dose without advice from your prescribing doctor or pharmacist (EMA product information). A doctor reviews your details and decides on the prescription. You can report suspected side effects in Germany through the BfArM and PEI reporting portal.

This Journal article offers general information about dizziness and light-headedness during prescribed weight-management treatment. It is not a diagnosis, a prescription or a promise of any result. Your prescribing doctor decides on suitability, dose changes and personal limits after clinical review. This article is for information and does not replace medical advice.