From the Guidelines
Clinicians should not routinely treat BPPV with vestibular suppressant medications such as antihistamines and/or benzodiazepines. This recommendation is based on the latest clinical practice guideline for benign paroxysmal positional vertigo (BPPV) published in 2017 1. The guideline suggests that the benefits of medical therapy do not outweigh the potential harms, and therefore, medications should not be used as a primary treatment for BPPV.
Alternative Treatment Options
Instead of medications, repositioning maneuvers such as the Epley or Semont maneuvers are recommended as the primary treatment for BPPV 1. These procedures have been shown to be effective in resolving symptoms and are considered the first-line treatment for posterior canal BPPV.
Role of Medications
However, in some cases, medications may be used to manage symptoms temporarily while waiting for repositioning treatment or if symptoms are severe. Vestibular suppressants such as meclizine (Antivert) or dimenhydrinate (Dramamine) may be used to reduce vertigo and associated nausea, but their use should be limited to a short period (2-3 days maximum) to avoid delaying central compensation and potentially prolonging recovery 1.
Importance of Proper Diagnosis and Treatment
It is essential to note that medications only mask symptoms rather than treat the underlying cause of BPPV, which is displaced calcium carbonate crystals in the inner ear's semicircular canals. Therefore, patients should seek proper diagnosis and canalith repositioning procedures from a healthcare provider experienced in treating vestibular disorders, even while using medication for symptom relief 1.
Key Takeaways
- Repositioning maneuvers are the primary treatment for BPPV
- Medications should not be used as a routine treatment for BPPV
- Medications may be used temporarily to manage symptoms in severe cases
- Proper diagnosis and treatment by a healthcare provider experienced in vestibular disorders is essential for effective management of BPPV.
From the FDA Drug Label
Meclizine hydrochloride tablets are indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults.
- Medication option: Meclizine (PO) is a treatment option for vertigo associated with diseases affecting the vestibular system, which includes Benign Paroxysmal Positional Vertigo (BPPV).
- Key use: Meclizine is used to treat vertigo, a common symptom of BPPV. 2
From the Research
BPPV Medication Options
There are limited studies that discuss medication options for Benign Paroxysmal Positional Vertigo (BPPV). However, the available evidence suggests that:
- Canalith repositioning procedures (CRP) are a common treatment for BPPV, with studies showing high success rates in resolving symptoms 3, 4.
- A study comparing vestibular rehabilitation (maneuver) to conventional therapy (medications) found no significant difference in symptom resolution between the two groups 5.
- The Epley maneuver, a type of CRP, has been shown to be an effective treatment for posterior canal BPPV, with a significant increase in complete resolution of vertigo symptoms compared to sham maneuvers or control groups 6.
Treatment Options
Some treatment options for BPPV include:
- Canalith repositioning procedures (CRP)
- Vestibular rehabilitation (maneuver)
- Epley maneuver
- Mastoid vibration with CRP for persistent cases of BPPV 7
- Medications, although the evidence for their effectiveness is limited
Key Findings
Key findings from the studies include:
- CRP is an efficient and long-lasting noninvasive treatment for BPPV, especially for younger patients without a history of head trauma or vestibular neuropathy 3, 4.
- The Epley maneuver is a safe and effective treatment for posterior canal BPPV, with a high success rate in resolving symptoms 6.
- There is a high recurrence rate of BPPV after treatment, with 36% of patients experiencing recurrence 6.