What medications are used to treat dizziness?

From the Guidelines

Vestibular suppressant medications are not recommended for the routine treatment of dizziness, except for short-term management of autonomic symptoms such as nausea or vomiting in severely symptomatic patients. The use of these medications, including benzodiazepines and antihistamines, has been shown to have limited effectiveness in treating dizziness and may even cause significant harm, such as drowsiness, cognitive deficits, and increased risk of falls 1.

For patients with benign paroxysmal positional vertigo (BPPV), canal repositioning maneuvers have been found to be more effective than medication alone, with studies showing substantially higher treatment responses and faster physical and mental recovery 1. However, in select patients, the addition of a benzodiazepine to canal repositioning maneuvers may decrease functional and emotional scores of the Dizziness Handicap Inventory, suggesting a role in treating psychological anxiety secondary to BPPV 1.

In some cases, betahistine may be effective in reducing symptoms in patients over 50 years old with hypertension, symptom onset less than 1 month, and brief attacks less than 1 minute, when used concurrently with canal repositioning maneuvers 1. Antiemetics may also be considered for prophylaxis in patients who have previously manifested severe nausea and/or vomiting with the Dix-Hallpike maneuvers and in whom a canal repositioning procedure is planned 1.

It is essential to identify and treat the underlying cause of dizziness rather than just managing symptoms, as dizziness can result from various conditions, including inner ear problems, medication side effects, or cardiovascular issues. A thorough evaluation and individualized treatment approach are necessary to improve outcomes and reduce the risk of adverse effects.

Key considerations for treatment include:

• Canal repositioning maneuvers as the primary treatment for BPPV
• Short-term use of vestibular suppressant medications for autonomic symptoms
• Selective use of benzodiazepines and betahistine in specific patient populations
• Emphasis on identifying and treating the underlying cause of dizziness
• Minimizing the risk of falls and other adverse effects associated with vestibular suppressant medications 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. DOSAGE AND ADMINISTRATION Recommended dosage: 25 mg to 100 mg daily, in divided doses The medication used to treat dizziness, specifically vertigo, is meclizine. The recommended dosage is 25 mg to 100 mg daily, in divided doses 2.

• Meclizine is indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults 2.

From the Research

Medications for Dizziness

Medications used to treat dizziness can be categorized based on their mechanism of action and the type of dizziness being treated. The following are some of the medications used:

• Vestibular suppressants: anticholinergic and antihistamine drugs, such as dimenhydrinate and benzodiazepines 3, 4
• Antidopaminergics: used to reduce neurovegetative and psychoaffective signs, such as nausea, vomiting, and anxiety 4
• Calcium channel antagonists: used to treat vestibular migraine 5
• Dopamine receptor antagonists: used to treat vertigo associated with migraine and certain strokes 5
• Betahistine: used to treat Menière's disease 3, 6
• Cinnarizine/dimenhydrinate: a fixed combination used to treat acute vertigo due to vestibular disorders 6
• Gabapentin: used to treat different forms of acquired and congenital nystagmus, and to reduce nystagmus and stabilize the visual field in acute vertigo 3, 7
• Corticosteroids: used to treat acute vestibular neuritis and Cogan's syndrome 3
• Selective serotonin reuptake inhibitors: used to treat phobic postural vertigo 3

Treatment Approaches

The treatment approach for dizziness depends on the underlying cause and may involve:

• Symptomatic treatment: aimed at eliminating the hallucination of motion and reducing accompanying symptoms 4
• Causal therapy: aimed at treating the underlying disorder, such as Menière's disease or vestibular migraine 3, 5
• Physical therapy: used to promote compensation for vestibular damage and to treat conditions such as benign paroxysmal positional vertigo (BPPV) 7, 5
• Empirical approach: used to treat patients with undetermined or ill-defined causes of vertigo, incorporating trials of medications and physical therapy 5