What medications are available in Canada for the treatment of vertigo?

Medications for Vertigo Treatment in Canada

For the treatment of vertigo in Canada, first-line medications include meclizine (12.5-100 mg daily), dimenhydrinate, and benzodiazepines for acute symptom management, while betahistine and diuretics are recommended for maintenance therapy in conditions like Ménière's disease. 1, 2

First-Line Medications for Acute Vertigo

Vestibular Suppressants

• Meclizine (Bonamine)

  • Dosage: 12.5-100 mg daily in divided doses 1
  • Mechanism: Antihistamine with anticholinergic properties
  • Cautions: May cause drowsiness; use with care in patients with asthma, glaucoma, or prostate enlargement 1

• Dimenhydrinate (Gravol)

  • Evidence shows it may be more effective than lorazepam for peripheral vertigo 3
  • Available in oral, injectable, and suppository forms in Canada

• Benzodiazepines

  • Diazepam (5 mg) has shown similar efficacy to meclizine (25 mg) for acute peripheral vertigo 4
  • Particularly useful for psychogenic vertigo and anxiety-related dizziness 5
  • Warning: Risk of dependence with prolonged use 6

Maintenance Therapy Options

• Betahistine

  • Recommended by guidelines for Ménière's disease to reduce symptoms or prevent attacks 2
  • Not FDA-approved in the US but available in Canada

• Diuretics

  • Recommended for Ménière's disease to reduce endolymphatic hydrops 2
  • Often combined with sodium restriction (less than 2g/day)

Adjunctive Medications

• Antiemetics

  • Metoclopramide (10 mg IV or oral)
  • Prochlorperazine (25 mg oral or suppository) 6
  • Useful for managing associated nausea and vomiting

• Calcium Channel Antagonists

  • Effective for vestibular migraine (e.g., flunarizine available in Canada) 7
  • Cinnarizine (often combined with dimenhydrinate) has shown superior efficacy to betahistine for acute vertigo 8

Condition-Specific Treatment Approaches

Benign Paroxysmal Positional Vertigo (BPPV)

• Canalith repositioning procedures are first-line (not medications)
• Medications generally not recommended as primary treatment 2

Ménière's Disease

• Betahistine and diuretics for maintenance
• Vestibular suppressants during acute attacks
• Sodium restriction (avoiding processed foods, reading food labels) 6
• Intratympanic steroids for refractory cases 2

Vestibular Neuritis

• Brief course of vestibular suppressants only
• Corticosteroids may be beneficial 7

Vestibular Migraine

• Prophylactic agents: calcium channel antagonists, beta-blockers, tricyclic antidepressants 5
• Acute treatment: triptans, NSAIDs

Important Considerations

• Most vestibular suppressants should be used short-term only as they may delay central compensation 2
• Avoid prolonged use of vestibular suppressants in elderly patients due to increased risk of falls and cognitive effects 2
• Lifestyle modifications that may help include:
  • Limiting salt/sodium intake
  • Avoiding excessive caffeine, alcohol, and nicotine
  • Managing stress appropriately
  • Getting adequate sleep 6

Medication Selection Algorithm

1. For acute vertigo attacks: Start with meclizine 25-50 mg or dimenhydrinate 50 mg
2. If anxiety is prominent: Consider adding a benzodiazepine (diazepam 5 mg)
3. For Ménière's disease: Add betahistine and/or diuretic for maintenance
4. For vestibular migraine: Use migraine prophylactic medications
5. For persistent symptoms: Consider referral to otolaryngology for condition-specific treatments

Remember that medication should be combined with appropriate non-pharmacological approaches, particularly canalith repositioning procedures for BPPV, which have success rates of 61-95% after a single treatment 2.