From the Guidelines
Vestibular suppressant medications are not routinely recommended for the treatment of dizziness, except for short-term management of autonomic symptoms such as nausea or vomiting in severely symptomatic patients. The most recent and highest quality study, published in 2017 1, suggests that these medications are not effective as a definitive, primary treatment for benign paroxysmal positional vertigo (BPPV) and may even pose significant harm, such as drowsiness, cognitive deficits, and increased risk of falls.
Some key points to consider when treating dizziness include:
- The use of canal repositioning maneuvers, such as the Epley maneuver, has been shown to be more effective than medication alone in treating BPPV 1.
- Betahistine may be effective in reducing symptoms in select patients, such as those over 50 years old with hypertension and brief attacks of dizziness 1.
- Benzodiazepines, such as diazepam, may be used short-term to decrease functional and emotional scores of the Dizziness Handicap Inventory, but their use should be cautious due to the risk of falls and cognitive deficits 1.
- Antiemetics may 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's essential to identify the underlying cause of dizziness before starting medication, as treatment should target the underlying condition. Staying hydrated, avoiding sudden movements, and getting up slowly from sitting or lying positions can also help manage dizziness symptoms alongside medication.
From the FDA Drug Label
Meclizine hydrochloride is indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults. The medicine for dizziness, specifically vertigo, is meclizine 2.
- Key points:
- Indication: Treatment of vertigo associated with diseases affecting the vestibular system in adults.
- Dosage: 25 mg to 100 mg daily, in divided doses. Note that while dizziness can be related to vertigo, the provided drug labels specifically mention vertigo, not dizziness in general.
From the Research
Medications for Dizziness
- The medication for dizziness can vary depending on the underlying cause of the condition.
- For benign paroxysmal positional vertigo (BPPV), medications such as betahistine and dimenhydrinate may be used to alleviate symptoms 3.
- Betahistine has been shown to be effective in improving residual dizziness symptoms in patients with BPPV after the Epley maneuver 3.
- Dimenhydrinate is also used to treat dizziness, but its effectiveness may vary depending on the individual case 3.
- Selective serotonin reuptake inhibitors (SSRIs) have been used to treat dizziness with psychiatric symptoms, and have been shown to be effective in relieving dizziness in patients with major or minor psychiatric symptoms 4.
- However, SSRIs can also cause dizziness as a symptom of abrupt discontinuation, particularly those with short half-lives and high selectivity for serotonin 5.
Treatment Options
- The Epley maneuver is a series of defined head positions that can be used to treat BPPV, and is often used in conjunction with medication 6, 7.
- The canalith repositioning procedure is another treatment option for BPPV, and has been shown to be effective in reducing symptoms of dizziness and vertigo 6, 7.
- Vestibular suppressants, such as meclizine, may also be used to treat dizziness, but their effectiveness can vary depending on the individual case 4.