From the Guidelines
Clinicians should not routinely treat vertigo symptoms with vestibular suppressant medications such as antihistamines or benzodiazepines, except for short-term management of autonomic symptoms like nausea or vomiting in severely symptomatic patients. The use of vestibular suppressant medications for vertigo symptoms is generally not recommended due to the potential for significant harm, including drowsiness, cognitive deficits, and increased risk of falls 1.
Instead, the focus should be on addressing the underlying cause of vertigo. For patients with benign paroxysmal positional vertigo (BPPV), canalith repositioning procedures are recommended as initial therapy 1. For vertigo caused by Ménière's disease, a limited course of vestibular suppressants may be offered for management of vertigo during attacks, with diuretics like hydrochlorothiazide potentially helping to reduce inner ear fluid 1.
It's essential to note that these medications are typically used for short-term management while the underlying cause is being addressed, and patients should seek medical evaluation to determine the specific cause of their vertigo for appropriate long-term management. Key considerations in managing vertigo include:
- Identifying and addressing the underlying cause
- Using vestibular suppressant medications judiciously and for the shortest duration necessary
- Considering the potential benefits and harms of medication use
- Focusing on therapies that target the root cause of vertigo, such as canalith repositioning procedures for BPPV or diuretics for Ménière's disease.
From the FDA Drug Label
MECLIZINE HYDROCHLORIDE tablets, for oral use Initial U. S. Approval: 1957 INDICATIONS AND USAGE Meclizine hydrochloride tablets are indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults (1).
Medications for Vertigo Symptoms:
- Meclizine hydrochloride tablets are used to treat vertigo symptoms, specifically those associated with diseases affecting the vestibular system in adults 2. Key Points:
- The recommended dosage is 25 mg to 100 mg daily, in divided doses.
- Meclizine hydrochloride tablets are available in 12.5 mg, 25 mg, and 50 mg strengths.
From the Research
Medications for Vertigo Symptoms
The following medications are used to treat vertigo symptoms:
- Anticholinergics, antihistamines, benzodiazepines, calcium channel antagonists, and dopamine receptor antagonists 3
- Vestibular suppressants such as anticholinergics and benzodiazepines for Ménière's disease and vestibular neuritis 3
- Diuretics for Ménière's disease 3, 4
- Prophylactic agents such as L-channel calcium channel antagonists, tricyclic antidepressants, and beta-blockers for migraine-associated vertigo 3
- Benzodiazepines for psychogenic vertigo 3
- Diazepam and meclizine for acute peripheral vertigo 5
Specific Conditions and Medications
- Ménière's disease: vestibular suppressants, diuretics, and salt restriction 3, 4
- Vestibular neuritis: brief use of vestibular suppressants 3
- Migraine-associated vertigo: prophylactic agents such as L-channel calcium channel antagonists, tricyclic antidepressants, and beta-blockers 3
- Psychogenic vertigo: benzodiazepines 3
- Acute peripheral vertigo: diazepam and meclizine 5