What is the effect of Meclizine (Antihistamine) on Benign Paroxysmal Positional Vertigo (BPPV)?

From the Guidelines

Meclizine should not be routinely used to treat benign paroxysmal positional vertigo (BPPV) due to the lack of evidence supporting its effectiveness as a primary treatment and the potential for significant harm, such as drowsiness, cognitive deficits, and increased risk of falls. The primary treatment for BPPV should be repositioning maneuvers like the Epley or Semont maneuvers, which physically move the displaced calcium carbonate crystals back to their proper location in the inner ear 1, 2. Meclizine may be considered for short-term management of autonomic symptoms, such as nausea or vomiting, in severely symptomatic patients, but its use should be cautious and limited due to the potential side effects 2.

Some key points to consider when treating BPPV include:

• Repositioning maneuvers, such as the Epley or Semont maneuvers, are the primary treatment for BPPV and have been shown to be effective in resolving symptoms 3
• Vestibular suppressant medications, including meclizine, have not been shown to be effective as a primary treatment for BPPV and may interfere with the brain's natural compensation mechanisms for vestibular disorders 1, 2
• The use of meclizine and other vestibular suppressant medications may be associated with significant harm, including drowsiness, cognitive deficits, and increased risk of falls, particularly in elderly patients 2

In terms of dosage and administration, meclizine is typically recommended at a dose of 25-50 mg taken 1-3 times daily as needed for vertigo symptoms, but this should be individualized based on patient response and tolerance. It is also important to be aware of the potential side effects of meclizine, including drowsiness, dry mouth, and blurred vision, and to advise patients to avoid driving or operating machinery while taking the medication 2.

From the FDA Drug Label

Meclizine hydrochloride tablets are indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults.

DOSAGE AND ADMINISTRATION Recommended dosage: 25 mg to 100 mg daily, in divided doses

• Meclizine can be used to treat vertigo associated with diseases affecting the vestibular system, which includes Benign Paroxysmal Positional Vertigo (BPPV).
• The recommended dosage is 25 mg to 100 mg daily, in divided doses.
• BPPV is a condition that affects the vestibular system, and meclizine can be used to treat the associated vertigo 4.

From the Research

Meclizine with BPPV

• Meclizine is a vestibular suppressant medication that is sometimes used to treat benign paroxysmal positional vertigo (BPPV) 5
• However, current guidelines do not recommend the use of meclizine for BPPV, as it has little therapeutic effect and can have side effects 5
• Instead, the most efficient management of BPPV is to perform a bedside test (Dix-Hallpike test) and then to treat the patients with a bedside positional (the Epley) maneuver 5
• The use of meclizine and other vestibular suppressant medications is considered suboptimal and can lead to unnecessary resource utilization, longer ED length of stay, and reduced patient-centered outcomes 5

Alternative Treatments for BPPV

• Canalith repositioning procedures (CRP) have been shown to be an efficient and long-lasting noninvasive treatment for BPPV, especially for younger patients without a history of head trauma or vestibular neuropathy 6
• The Epley maneuver is a commonly used CRP that has been shown to be effective in treating posterior canal BPPV 7, 8, 5
• Other CRPs, such as the Semont and Gufoni's maneuvers, have also been shown to be effective in treating BPPV, although the choice of maneuver may depend on the clinician's preferences and the patient's specific condition 7

Considerations for Treatment

• The treatment of BPPV can be challenging, and clinicians must remain vigilant and mindful of the possibility of post-treatment otolithic crisis following the treatment of BPPV 8
• Repeated testing and treatment of BPPV within the same session is promoted as a safe and effective approach to the management of BPPV, with a low risk of canal conversion 8
• Clinicians must also be aware of the potential for recurrence and the need for ongoing management and follow-up care 6, 8