What medications are used to treat vertigo?

From the Guidelines

Vertigo is typically treated with repositioning maneuvers, and medications such as vestibular suppressants are not recommended for routine treatment, except for short-term management of autonomic symptoms like nausea or vomiting in severely symptomatic patients. The choice of medication depends on the underlying cause of vertigo, with antihistamines like meclizine (Antivert) at 25-50mg every 4-6 hours, dimenhydrinate (Dramamine) at 50mg every 4-6 hours, or diphenhydramine (Benadryl) at 25-50mg every 6-8 hours helping to reduce vertigo symptoms by suppressing the vestibular system 1. Benzodiazepines such as diazepam (Valium) at 2-5mg every 6-8 hours or lorazepam (Ativan) at 0.5-1mg every 8 hours work by reducing anxiety and suppressing vestibular responses. For vertigo caused by Meniere's disease, diuretics like hydrochlorothiazide at 25mg daily may help reduce inner ear fluid, and a limited course of vestibular suppressants can be offered for management of vertigo only during Meniere’s disease attacks 1. Antiemetics such as promethazine (Phenergan) at 12.5-25mg every 4-6 hours or ondansetron (Zofran) at 4-8mg every 8 hours can control associated nausea.

Some key points to consider when treating vertigo include:

• The importance of diagnosing the underlying cause of vertigo to determine the most effective treatment approach
• The use of repositioning maneuvers as a first-line treatment for benign paroxysmal positional vertigo (BPPV) 1
• The potential risks and benefits of using vestibular suppressant medications, including the risk of falls and cognitive deficits 1
• The importance of patient education and shared decision-making in the treatment of vertigo 1

It's also important to note that vestibular suppressant medications are not recommended for routine treatment of BPPV, except for short-term management of autonomic symptoms like nausea or vomiting in severely symptomatic patients 1. Instead, repositioning maneuvers and observation are recommended as initial management for patients with BPPV 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 medication used to treat vertigo is meclizine, which is administered orally (PO) 2.

• Key use: Treatment of vertigo associated with diseases affecting the vestibular system in adults.

From the Research

Medications for Vertigo

The treatment of vertigo often involves the use of various medications to alleviate symptoms. According to 3, the approach to drug treatment of vertigo is almost exclusively symptomatic, with three major goals:

• Eliminate the hallucination of motion
• Reduce accompanying neurovegetative and psychoaffective signs
• Enhance the process of vestibular compensation

Types of Medications

Some of the medications used to treat vertigo include:

• Anticholinergic and antihistamine drugs, which have vestibular 'suppressant' properties 3
• Antidopaminergics, which are used to reduce neurovegetative and psychoaffective signs 3
• Benzodiazepines, histaminergic agents, sympathomimetics, and calcium antagonists, although their mechanism of action is poorly understood 3
• Levo-sulpiride, methoclopramide, and triethilperazine, which are used to reduce neurovegetative symptoms 4
• Diazepam, which is used to decrease internuclear inhibition 4
• Gabapentine, which is used to reduce nystagmus and stabilize the visual field 4

Specific Conditions

For specific conditions such as Ménière's disease, diuretics such as isosorbide, hydrochlorothiazide, and acetazolamide may be used to improve vertigo outcomes 5. In the case of benign paroxysmal positional vertigo (BPPV), vestibular suppressant medications such as meclizine are not recommended, and instead, a bedside test (Dix-Hallpike test) and a bedside positional (the Epley) maneuver are preferred 6.

Treatment Approach

The treatment approach for vertigo often involves a combination of medications and physical therapy. According to 7, supportive treatment, antiemetic, and vestibular blocking agents can help relieve an acute vertigo attack, but prolonged use of such medications is not recommended. Vestibular rehabilitation programs, including patient education and home-based exercises, can also be effective in managing chronic vertigo 7.