From the Guidelines
Clinicians should not routinely treat vertigo with vestibular suppressant medications such as antihistamines and/or benzodiazepines. The treatment of vertigo depends on its cause, and the most recent evidence suggests that repositioning maneuvers, such as the Epley maneuver, are more effective than medication in treating benign paroxysmal positional vertigo (BPPV) 1.
Key Points to Consider
- Vestibular suppressant medications have the potential for significant harm, including drowsiness, cognitive deficits, and interference with driving or operating machinery 1.
- The use of these medications can also increase the risk of falls, particularly in the elderly 1.
- Repositioning procedures, such as the canalith repositioning procedure, are recommended as initial therapy for patients with posterior canal BPPV 1.
- Vestibular rehabilitation may also be offered as a treatment option for BPPV 1.
Recommendations
- Clinicians should diagnose and treat vertigo based on its cause, and repositioning maneuvers should be considered as a first-line treatment for BPPV 1.
- Vestibular suppressant medications should only be used in select cases, such as for the short-term management of autonomic symptoms, such as nausea or vomiting, in a severely symptomatic patient 1.
- Patients should be educated regarding the impact of BPPV on their safety, the potential for disease recurrence, and the importance of follow-up 1.
From the FDA Drug Label
Meclizine hydrochloride tablets are indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults (1).
The best medication for vertigo, based on the available information, is meclizine (PO), as it is directly indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults 2.
From the Research
Medications for Vertigo
- The following medications are useful in the treatment of vertigo:
- Anticholinergics
- Antihistamines
- Benzodiazepines
- Calcium channel antagonists
- Dopamine receptor antagonists 3
- For Ménière's disease and vestibular neuritis, vestibular suppressants such as anticholinergics and benzodiazepines are used 3
- For vertigo associated with migraine, prophylactic agents such as L-channel calcium channel antagonists, tricyclic antidepressants, and beta-blockers are used 3
- Benzodiazepines are the most useful agents for psychogenic vertigo 3
Comparison of Medications
- Diazepam and meclizine are equally effective in the treatment of vertigo 4
- Ondansetron and promethazine are also effective in treating acute peripheral vertigo, with promethazine being more efficient in curing vertigo and ondansetron being more beneficial for improving nausea and vomiting 5
- Betahistine may have a positive effect in reducing vertigo symptoms, with low quality evidence suggesting its effectiveness 6
Treatment Approaches
- The treatment of vertigo is optimized when the prescriber has detailed knowledge of the pharmacology of medications being administered as well as the precise actions being sought 3
- A tailored approach to treatment is recommended, taking into account the underlying cause of vertigo 3, 7
- Vestibular rehabilitation physical therapy is often recommended in an attempt to promote compensation for vestibular damage 3