What medications are used to treat vertigo (giddiness)?

Medications for Giddiness (Vertigo)

Vestibular suppressant medications should not be routinely used for treating benign paroxysmal positional vertigo (BPPV), but may be considered for short-term management of severe symptoms like nausea and vomiting. 1

Common Medications Used for Vertigo Symptoms

Antihistamines

• Meclizine (12.5-100 mg daily in divided doses) is indicated for treatment of vertigo associated with vestibular system diseases 2
• Common side effects include drowsiness (use caution when driving), dry mouth, headache, and fatigue 2
• Meclizine appears to have a suppressive effect on the central emetic center to relieve nausea and vomiting associated with motion sickness 1
• Diphenhydramine is another antihistamine commonly used for vertigo symptoms 1

Benzodiazepines

• Diazepam and clonazepam have anxiolytic, sedative, and muscle relaxant properties 1
• These medications can reduce the subjective sensation of spinning in prolonged dizziness 1
• However, they may interfere with central compensation in peripheral vestibular conditions 1
• In a comparative study, diazepam (5 mg) and meclizine (25 mg) showed similar effectiveness in treating acute peripheral vertigo in emergency settings 3

Other Medications

• Promethazine (a phenothiazine with antihistamine properties) is often used for motion sickness 1
• Ondansetron (a serotonin-5-hydroxytryptamine-3 antagonist) may help with motion sickness symptoms 1
• Scopolamine (transdermal) is effective for motion sickness prevention, delivering approximately 5 μg/hour over a 3-day period 4
• Scopolamine was found to be more effective than oral meclizine for motion sickness prevention 4

Medication Selection Based on Vertigo Type

For BPPV

• Vestibular suppressant medications are not recommended as primary treatment 1
• Repositioning maneuvers are the preferred first-line treatment 1
• Medications should only be used for short-term management of severe vegetative symptoms 1

For Ménière's Disease

• Diuretics (thiazides, potassium-sparing, loop, and carbonic anhydrase inhibitors) may be used to reduce endolymph volume 1
• Betahistine has shown mixed results - a Cochrane review suggested benefit, but the more recent BEMED trial found no significant difference compared to placebo 1
• For refractory cases, intratympanic steroid therapy or gentamicin may be considered 1

Pharmacological Properties and Mechanisms

• Meclizine primarily affects the semicircular canal-induced vestibulo-ocular reflex gain, suggesting central action on the medial vestibular nucleus 5
• Scopolamine and lorazepam primarily affect utricular sensitivity 5
• Promethazine causes global vestibular suppression due to its anticholinergic, antihistaminergic, and antidopaminergic properties 5
• CYP2D6 is the dominant enzyme for metabolism of meclizine, and its genetic polymorphism could contribute to large interindividual variability in response 6

Important Considerations and Cautions

• Vestibular suppressants may decrease diagnostic sensitivity during Dix-Hallpike maneuvers 1
• These medications can cause adverse effects or medication interactions 1
• Drowsiness is a common side effect that can impair driving and operation of machinery 2
• Betahistine should be used with caution in patients with asthma and history of peptic ulcer disease 1
• Patients should be reassessed within 1 month after initial treatment to confirm symptom resolution 1
• Meclizine in suspension form may provide faster onset of action compared to tablet formulation 6