What is the initial treatment for central vertigo?

From the FDA Drug Label

Meclizine hydrochloride is indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults. The initial treatment for central vertigo is not explicitly stated in the provided drug labels, as they mention vertigo associated with diseases affecting the vestibular system, but do not specifically distinguish between central and peripheral vertigo.

• Key Point: The drug labels provided do not directly address the treatment of central vertigo. 1 1 1

From the Research

The initial treatment for central vertigo should focus on addressing the underlying cause while managing symptoms with vestibular suppressants like diazepam, meclizine, or promethazine, and physical therapy with vestibular rehabilitation exercises, as recommended by recent studies 2, 3. The treatment approach for central vertigo involves a combination of pharmacological and non-pharmacological interventions.

• Vestibular suppressants such as diazepam (2-5mg every 4-6 hours as needed), meclizine (25mg every 6-8 hours), or promethazine (25mg every 4-6 hours) can help control acute symptoms by suppressing vestibular input to the brain, reducing the sensation of spinning 3.
• However, these medications should be used short-term (3-5 days) as prolonged use can delay central compensation mechanisms, as noted in studies 3, 4.
• For nausea, antiemetics such as ondansetron (4-8mg every 8 hours) may be added to the treatment regimen, as suggested by clinical guidelines 2.
• Physical therapy with vestibular rehabilitation exercises should be initiated early to promote neuroplasticity and improve balance, as recommended by recent studies 2, 5.
• Patients should be advised to move slowly, avoid sudden head movements, and ensure a safe environment to prevent falls, as part of a comprehensive treatment plan 6. The definitive treatment ultimately depends on identifying and treating the specific cause, which may include stroke, multiple sclerosis, tumors, or other central nervous system disorders, and imaging studies like MRI are typically necessary to determine the underlying etiology and guide long-term management 2, 3.