What is the strength of medications for Vertigo (Vestibular disorder)?

From the Guidelines

Vestibular suppressant medications are not recommended for the routine treatment of benign paroxysmal positional vertigo (BPPV), except for short-term management of autonomic symptoms such as nausea or vomiting in severely symptomatic patients. The use of these medications, including antihistamines and benzodiazepines, has been shown to have no significant benefit in treating BPPV and may even cause harm, such as drowsiness, cognitive deficits, and increased risk of falls 1.

Key Points to Consider

• The American Academy of Otolaryngology-Head and Neck Surgery recommends against the routine use of vestibular suppressant medications for BPPV treatment 1.
• Repositioning procedures, such as the canalith repositioning procedure, are recommended as initial therapy for patients with posterior canal BPPV 1.
• Vestibular rehabilitation exercises may be offered to patients with BPPV to promote long-term recovery and prevent recurrence 1.
• Patient education is crucial in managing BPPV, including information on the impact of BPPV on safety, potential for disease recurrence, and importance of follow-up 1.

Medication Use

• If medications are used, they should be prescribed for the shortest duration possible, typically 3-5 days for acute vertigo, to avoid delaying central compensation mechanisms and natural recovery.
• Antiemetics, such as ondansetron, may be considered for prophylaxis in patients who have previously manifested severe nausea and/or vomiting with the Dix-Hallpike maneuvers and in whom a canalith repositioning procedure is planned 1.

Prioritizing Patient Safety

• Clinicians should assess patients with BPPV for factors that modify management, including impaired mobility or balance, central nervous system disorders, lack of home support, and/or increased risk for falling 1.
• The potential for polypharmacy and the risk of falls should be carefully considered when prescribing medications for BPPV treatment 1.

From the FDA Drug Label

DOSAGE FORMS AND STRENGTHS Tablets: 12. 5 mg, 25 mg and 50 mg (3) The strengths of meclizine for vertigo are:

• 12.5 mg
• 25 mg
• 50 mg 2

From the Research

Strength of Medicines for Vertigo

The strength of medicines for vertigo can vary depending on the underlying cause of the condition.

• Benign paroxysmal positional vertigo (BPPV) usually improves with a canalith repositioning procedure 3.
• Acute vestibular neuronitis or labyrinthitis improves with initial stabilizing measures and a vestibular suppressant medication, followed by vestibular rehabilitation exercises 3.
• Meniere's disease often responds to the combination of a low-salt diet and diuretics 3, 4.
• Vertiginous migraine headaches generally improve with dietary changes, a tricyclic antidepressant, and a beta blocker or calcium channel blocker 3.
• Vertigo associated with anxiety usually responds to a selective serotonin reuptake inhibitor 3.

Pharmacological Management of Vertigo

The pharmacological management of vertigo in Meniere's disease is limited, with evidence supporting the efficacy of betahistine, diuretics, and intratympanic administration of corticosteroids or gentamicin being limited 5.

• Randomized clinical trials should consider stratification by Meniere's disease clinical subgroups 5.
• The treatment plan should be personalized according to the clinical subgroup, hearing stage, duration of the disease, vertigo attack profile, and comorbidities 5.

Treatment of Vestibular Vertigo

Vestibular vertigo is most often caused by BPPV, Meniere's disease, vestibular neuritis, vestibular migraine, or stroke 6.

• Features, diagnosis, and treatment of vestibular vertigo in patients with these diseases are discussed 6.
• BPPV, Meniere's disease, and migraine are effectively treated and therefore their diagnosis and adequate treatment are of great importance 6.

Management of Vestibular Disorders

Vertigo and dizziness are not disease entities but rather the outcome of many pathological or physiological processes 7.

• The prevailing good prognosis of vestibular disorders that manifest with vertigo must be emphasized 7.
• Most forms of vertigo have a benign cause and are characterized by spontaneous recovery of vestibular function or central compensation of a peripheral or central vestibular tone imbalance 7.
• Vertigo can be effectively relieved by pharmacological treatment, physical therapy, surgery, or psychotherapy 7.