What medications are used to treat vertigo?

Medications for Vertigo Treatment

For vertigo treatment, meclizine is the most commonly used first-line medication for peripheral vertigo, while specific treatments should be tailored based on the underlying cause, with vestibular suppressants used only for short-term management of severe symptoms rather than as definitive treatment. 1, 2

First-Line Medications Based on Vertigo Type

• Meclizine (25-100 mg daily in divided doses) is FDA-approved for vertigo associated with diseases affecting the vestibular system in adults and works by suppressing the central emetic center 2
• For Benign Paroxysmal Positional Vertigo (BPPV), medications are not recommended as primary treatment; instead, canalith repositioning maneuvers are first-line with 80% success rates 1
• For Ménière's disease attacks, diuretics and/or betahistine are recommended for maintenance therapy, with vestibular suppressants only during acute attacks 3, 4
• For vestibular migraine, prophylactic agents like calcium channel antagonists, tricyclic antidepressants, and beta-blockers are the mainstay of treatment 5

Vestibular Suppressant Medications

• Antihistamines (meclizine being most common) should be used primarily as-needed rather than on a scheduled basis to avoid interfering with vestibular compensation 1, 4
• Benzodiazepines may be used for short-term management of severe vertigo symptoms and can help with psychological anxiety secondary to vertigo 1, 4
• Prochlorperazine can be used for short-term management of severe nausea/vomiting associated with vertigo 1, 4
• Anticholinergics are another class of vestibular suppressants that can be used for symptomatic relief 5, 6

Important Cautions and Side Effects

• Vestibular suppressants can cause significant side effects including drowsiness, cognitive deficits, and interference with driving 1, 2
• These medications are a significant independent risk factor for falls, especially in elderly patients 7, 1
• Long-term use of vestibular suppressants can interfere with central compensation in peripheral vestibular conditions 7, 4
• Meclizine has potential anticholinergic actions and should be prescribed with care to patients with a history of asthma, glaucoma, or enlargement of the prostate gland 2

Treatment Algorithm

1. Identify vertigo type:

   • BPPV: Canalith repositioning maneuvers as first-line; medications not recommended 1
   • Ménière's disease: Diuretics and/or betahistine for maintenance; vestibular suppressants only for acute attacks 3
   • Vestibular neuritis: Brief use of vestibular suppressants only 5
   • Vestibular migraine: Prophylactic agents (calcium channel antagonists, tricyclics, beta-blockers) 5

2. For acute symptomatic relief:

   • Meclizine 25-100 mg daily in divided doses 2
   • For severe nausea/vomiting: Add prochlorperazine for short-term management 4
   • For anxiety component: Consider short-term benzodiazepine use 4

3. Duration of treatment:

   • Use vestibular suppressants for no longer than one week to avoid inhibiting beneficial compensatory processes 8
   • Reassess within 1 month to document resolution or persistence of symptoms 1, 4

Lifestyle Modifications

• Limit salt/sodium intake, especially for Ménière's disease 1, 4
• Avoid excessive caffeine, alcohol, and nicotine 1, 4
• Maintain adequate hydration and regular sleep patterns 1
• Implement appropriate stress management techniques 1, 4

Common Pitfalls to Avoid

• Using vestibular suppressants as primary treatment for BPPV instead of canalith repositioning maneuvers 1
• Continuing vestibular suppressants long-term, which can delay recovery by interfering with central compensation 7, 4
• Prescribing meclizine routinely for elderly patients without considering the significant fall risk and anticholinergic side effects 7, 1
• Failing to transition from medication to vestibular rehabilitation when appropriate to promote long-term recovery 1, 4