Acquired Nystagmus Medication

Updated: Jun 22, 2021
  • Author: Huy D Nguyen, MD, MBA; Chief Editor: Edsel B Ing, MD, PhD, MBA, MEd, MPH, MA, FRCSC  more...
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Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

The potassium channel blocker 3,4-diaminopyridine has been suggested as an off-label treatment for downbeat nystagmus. [2, 39]



Class Summary

Increases GABA synthesis and release and decreases GABA degradation. Used for acquired pendular nystagmus. [ [37] ]

Gabapentin (Neurontin)

May reduce nystagmus, improve visual acuity, and reduce oscillopsia in patients with acquired pendular nystagmus. Relatively few drug interactions and mild, tolerable side effects.

Clonazepam (Klonopin)

Used for downbeat and seesaw nystagmus. Suppresses muscle contractions by facilitating inhibitory GABA neurotransmission and other inhibitory transmitters. Concentrations of clonazepam may increase if it is given in conjunction with oral antifungal agents due to the inhibition of cytochrome P450-3A. Common side effects include ataxia, dizziness, depression and amnesia. 


Muscle relaxants, GABA agonists

Class Summary

Use for periodic alternating nystagmus, downbeat and upbeat nystagmus, and seesaw nystagmus. [ [40] , [37] ]

Baclofen (Lioresal)

Periodic alternating oscillopsia may be a major complaint in patients with periodic alternating nystagmus and may be cured by the use of baclofen. May cause an increased risk of respiratory and central nervous system depression if used with narcotics, especially propoxyphene. 



Neuromuscular blocker agents

Class Summary

Blocks neuromuscular transmission at cholinergic junctions by preventing release of acetylcholine from nerve terminals. Decreases nystagmus and improves visual acuity. [ [41] ]

OnabotulinumtoxinA (BOTOX®)

Treats excessive, abnormal contractions associated with blepharospasm. Binds to receptor sites on motor nerve terminals and inhibits release of acetylcholine, which, in turn, inhibits transmission of neural impulses at neuromuscular junctions. May also be useful for suppressing compensatory head tilting or tremors that develop to allow visual fixation in the presence of a nystagmus.

Reexamine patients 7-14 d after initial dose to assess for response. Increase doses 2-fold over previous one for patients experiencing incomplete paralysis of target muscle. Do not exceed 25 U when giving it as single injection or 200 U as cumulative dose in 30-day period.