What is an alternative medication for vertigo (dizziness)?

From the Guidelines

Betahistine is not recommended as a first-line treatment for vertigo due to its lack of significant efficacy in reducing vertigo attacks compared to placebo, as shown in the BEMED trial 1. Instead, other effective options for managing vertigo include:

• Meclizine, with a typical dosage of 25-50 mg taken orally up to three times daily as needed for symptoms
• Dimenhydrinate, with a dosage of 50-100 mg every 4-6 hours
• Promethazine, with a dosage of 25 mg every 4-6 hours
• Diazepam, with a dosage of 2-5 mg every 6-8 hours for severe cases These medications work by either suppressing vestibular sensory input to the brain or by affecting histamine receptors involved in balance regulation. It's essential to note that betahistine should be used with caution in patients with asthma and history of peptic ulcer disease and avoided in patients with pheochromocytoma, as reported in the study 1. Additionally, patients should be educated about the natural history of Meniere's disease, measures for symptom control, treatment options, and outcomes, as emphasized in the clinical practice guideline 1. The goal of treatment is to prevent or reduce the severity and frequency of vertigo attacks, relieve or prevent hearing loss, tinnitus, and aural fullness, and improve overall quality of life, as stated in the guideline 1. Therefore, a comprehensive approach to managing vertigo should prioritize patient education, lifestyle modifications, and evidence-based pharmacotherapy.

From the Research

Alternative Medications for Vertigo

• Betahistine is a commonly used medication for the treatment of vertigo, particularly in patients with Ménière's disease 2, 3, 4, 5, 6
• The efficacy of betahistine in treating vertigo has been demonstrated in several clinical trials, with some studies showing significant improvements in symptoms 3, 4
• However, other studies have found that the evidence for the effectiveness of betahistine is not conclusive, and more research is needed to fully understand its benefits and risks 5

Other Treatment Options

• Other medications that may be used to treat vertigo include anticholinergics, benzodiazepines, cinnarizine, and phenothiazines 4
• Non-drug interventions, such as vestibular rehabilitation and dietary modifications, may also be effective in managing vertigo symptoms 4, 6
• Intratympanic interventions, such as the injection of corticosteroids or gentamicin, may be considered for patients with severe or refractory vertigo 6

Safety and Efficacy

• Betahistine has been shown to be generally safe and well-tolerated, with few adverse effects reported in clinical trials 3, 5
• However, the long-term efficacy and safety of betahistine are not well established, and further research is needed to fully understand its effects 5