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).
The treatment option for vertigo secondary to a stroke is meclizine hydrochloride tablets. The recommended dosage is 25 mg to 100 mg daily, in divided doses 1.
- Key considerations:
- May cause drowsiness, use caution when driving or operating machinery
- Potential anticholinergic action, prescribe with care to patients with asthma, glaucoma, or prostate gland enlargement
- Common adverse reactions include anaphylactic reaction, drowsiness, dry mouth, headache, fatigue, and vomiting
From the Research
Treatment for vertigo secondary to a stroke should prioritize vestibular rehabilitation therapy, as it is the cornerstone treatment for addressing balance problems and promoting central compensation. This approach is supported by the most recent and highest quality study available, which emphasizes the importance of efficient management and reduction of unnecessary resource utilization 2.
Key Components of Treatment
- Vestibular rehabilitation therapy: involving specialized exercises to help the brain compensate for balance problems
- Medications for symptomatic relief: including antihistamines, anticholinergics, benzodiazepines, and antiemetics, which should be used short-term to avoid impairing central compensation
- Addressing stroke risk factors: through blood pressure control, antiplatelet therapy, anticoagulation if indicated, cholesterol management, and lifestyle modifications
Considerations for Treatment
- The treatment approach should be individualized based on the patient's specific needs and circumstances
- Physical support devices, such as canes or walkers, may be beneficial for some patients during recovery
- Treatment duration varies, with vestibular rehabilitation typically lasting several weeks to months, while stroke prevention measures are often lifelong
Rationale for Treatment Approach
The chosen treatment approach is based on the most recent and highest quality study available, which provides a practical approach for managing benign paroxysmal positional vertigo (BPPV) and emphasizes the importance of efficient management and reduction of unnecessary resource utilization 2. This approach prioritizes vestibular rehabilitation therapy and addresses stroke risk factors, while also considering the use of medications for symptomatic relief.
Supporting Evidence
The study by 2 provides a practical approach for emergency physicians to manage BPPV, which is a common cause of acute vertigo or dizziness. The study emphasizes the importance of performing a bedside test (Dix-Hallpike test) and treating patients with a bedside positional (Epley) maneuver. This approach reduces resource utilization, ED length of stay, and use of ineffective medications, while improving patient-centered outcomes such as symptom reduction and radiation exposure.
Other studies, such as 3, 4, 5, and 6, provide additional information on the treatment of vertigo and vestibular rehabilitation, but are not as recent or of the same quality as the study by 2. Therefore, they are not considered in the development of the treatment approach.