What medications are used to treat vertigo?

Medications for Vertigo Treatment

Medication selection for vertigo should be based on the underlying cause, with vestibular suppressants recommended only for short-term symptomatic relief rather than as definitive treatment. 1

First-Line Approach by Vertigo Type

Benign Paroxysmal Positional Vertigo (BPPV)

• Canalith repositioning procedures (e.g., Epley maneuver) are strongly recommended as first-line treatment for BPPV, not medications 2, 1
• Vestibular suppressant medications like antihistamines or benzodiazepines are explicitly not recommended for routine treatment of BPPV 2, 1
• Medications do not address the underlying cause of BPPV and have substantially lower treatment response (30.8%) compared to repositioning maneuvers (78.6%-93.3%) 1

Ménière's Disease

• Limited course of vestibular suppressants recommended only during acute attacks 1, 3
• Dietary modifications including salt restriction and diuretics are used for prevention 1, 4

Vestibular Neuritis/Labyrinthitis

• Short-term vestibular suppressants for acute symptom management 4
• Transition to vestibular rehabilitation exercises for long-term recovery 1

Medication Options for Symptomatic Relief

Antihistamines

• Meclizine (25-100 mg daily in divided doses) is FDA-approved for "treatment of vertigo associated with diseases affecting the vestibular system" 5
• Should be used primarily as-needed rather than scheduled to avoid interfering with vestibular compensation 1
• Common side effects include drowsiness, dry mouth, headache, fatigue, and vomiting 5

Antiemetics

• Prochlorperazine may be used for short-term management of severe nausea/vomiting associated with vertigo 1, 3
• Not recommended as primary treatment for vertigo itself 1

Benzodiazepines

• May be used for short-term management of severe vertigo symptoms, especially with anxiety component 3
• Can help with psychological anxiety secondary to vertigo 1

Important Cautions

• Vestibular suppressants can cause significant side effects including drowsiness, cognitive deficits, and increased risk of falls, especially in elderly patients 1, 3
• Long-term use can interfere with central compensation in peripheral vestibular conditions 6, 3
• Anticholinergic effects of meclizine require caution in patients with asthma, glaucoma, or prostate enlargement 5
• Coadministration with other CNS depressants, including alcohol, may increase CNS depression 5

Follow-Up Recommendations

• Patients should be reassessed within 1 month after initial treatment to document resolution or persistence of symptoms 2, 1
• Transition from medication to vestibular rehabilitation when appropriate to promote long-term recovery 1, 3
• Discontinue vestibular suppressants as soon as possible to avoid interfering with natural compensation 6

Lifestyle Modifications

• Limit salt/sodium intake, especially for Ménière's disease 1, 3
• Avoid excessive caffeine, alcohol, and nicotine 1
• Maintain adequate hydration, regular exercise, and sufficient sleep 1
• Manage stress appropriately 1

Common Pitfalls to Avoid

• Using medications as primary treatment for BPPV instead of repositioning maneuvers 2, 1
• Continuing vestibular suppressants long-term, which delays recovery by interfering with central compensation 6
• Failing to transition from medication to vestibular rehabilitation for long-term management 1, 3
• Overlooking the increased fall risk in elderly patients taking vestibular suppressants 1, 6