From the Guidelines
Meclizine should not be used as a primary treatment for vertigo, especially in cases of benign paroxysmal positional vertigo (BPPV), as it can delay central compensation mechanisms and is not recommended by recent guidelines 1. Instead, treatment of vertigo should focus on addressing the underlying cause, such as with canalith repositioning procedures (CRPs) for BPPV or other management strategies for Meniere's disease.
- For BPPV, the use of CRPs, such as the Epley maneuver, is recommended as a first-line treatment 1.
- For Meniere's disease, vestibular suppressants like meclizine may be offered for a limited course to manage vertigo during attacks, but this should be done with caution and consideration of the potential for delayed central compensation 1. Key points to consider in the management of vertigo include:
- Identifying the underlying cause of vertigo to guide treatment
- Using CRPs for BPPV
- Limiting the use of vestibular suppressants to short-term management of severe symptoms
- Focusing on improving quality of life and reducing the impact of vertigo on daily activities It's also important to note that meclizine can have side effects such as drowsiness, dry mouth, and blurred vision, and patients should be advised to avoid driving or operating machinery until they know how the medication affects them 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). Recommended dosage: 25 mg to 100 mg daily, in divided doses (2.1).
Vertigo Treatment with Meclizine:
- Meclizine is indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults.
- The recommended dosage is 25 mg to 100 mg daily, in divided doses.
- 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 drowsiness, dry mouth, headache, fatigue, and vomiting. 2
From the Research
Vertigo Treatment
- Vertigo is a debilitating disease that can be treated with various medications, including antihistamines like meclizine 3.
- Meclizine is an antihistamine that is commonly used to alleviate symptoms of vertigo 4.
- A study comparing diazepam and meclizine found that they are equally effective in the treatment of vertigo 4.
Meclizine Efficacy
- Meclizine has been shown to be effective in reducing the symptoms of vertigo, with a mean improvement of 40 mm on a 100-mm visual analog scale (VAS) after 60 minutes of treatment 4.
- Another study found that a fixed combination of cinnarizine and dimenhydrinate was more effective than betahistine in reducing vertigo symptoms 5.
- However, meclizine was not directly compared to other treatments in this study.
Treatment Approaches
- The treatment of vertigo depends on the underlying cause, with different medications and therapies used for different types of vertigo 3, 6.
- For example, otological vertigo may be treated with vestibular suppressants like anticholinergics and benzodiazepines, while central vertigo may be treated with prophylactic agents like calcium channel antagonists 3.
- Physical therapy, such as vestibular rehabilitation, may also be used to promote compensation for vestibular damage 3, 6.
Comparison with Other Treatments
- A study comparing the Epley maneuver, betahistine, and dimenhydrinate found that betahistine or dimenhydrinate may be effective in reducing symptoms of benign paroxysmal positional vertigo (BPPV) 7.
- However, meclizine was not included in this study, and its efficacy in comparison to these treatments is unknown.