What medication is recommended for treating dizziness?

Medication for Dizziness

For acute vertigo, meclizine 25-100 mg daily in divided doses is the FDA-approved first-line medication, though it should only be used for short-term symptomatic relief (5-7 days maximum) and never as primary treatment for benign paroxysmal positional vertigo (BPPV), where repositioning maneuvers are definitively superior. 1, 2

Critical First Step: Identify the Underlying Cause

The choice of medication depends entirely on the etiology of dizziness, as treatment varies dramatically:

For BPPV (Most Common Cause)

• Do NOT use meclizine as primary treatment - the American Academy of Otolaryngology-Head and Neck Surgery explicitly recommends against routine vestibular suppressant use for BPPV 1, 3
• Canalith repositioning maneuvers (Epley maneuver) achieve 78.6-93.3% improvement versus only 30.8% with medication alone 3
• Meclizine may only be considered for severe nausea/vomiting during repositioning procedures or as prophylaxis before the maneuver in patients with prior severe nausea 3
• Patients recover faster with repositioning alone compared to repositioning plus vestibular suppressants 3

For Ménière's Disease

• Vestibular suppressants are appropriate for acute attacks only 4, 3
• Meclizine 25-100 mg daily in divided doses for symptomatic relief during acute vertigo episodes 1, 2
• Prochlorperazine 5 mg three times daily or 25 mg orally/suppository (maximum 3 doses per 24 hours) for severe nausea and vomiting 4, 5
• Long-term management focuses on dietary sodium restriction and lifestyle modifications, not chronic medication use 4, 3

For Vestibular Neuritis

• Brief course only - vestibular suppressants should be discontinued quickly to avoid delaying central compensation 6
• Meclizine 25 mg three times daily for 5-7 days maximum 1
• Consider corticosteroids for the underlying inflammatory process (not a vestibular suppressant) 6

For Migraine-Associated Vertigo

• Prophylactic medications are the mainstay, not acute vestibular suppressants 6
• Calcium channel antagonists, tricyclic antidepressants, or beta-blockers for prevention 6
• Prochlorperazine can be effective for acute migraine-associated vertigo with headache pain 5

Specific Medication Recommendations

Meclizine (First-Line for Peripheral Vertigo)

• FDA-approved dosing: 25-100 mg daily in divided doses 2
• Practical dosing: 25 mg three times daily for 5-7 days 1
• Use as-needed rather than scheduled to avoid interfering with vestibular compensation 3
• Swallow tablets whole 2

Critical warnings:

• Causes drowsiness - caution with driving or operating machinery 2
• Anticholinergic effects: use with care in asthma, glaucoma, or prostate enlargement 2
• Significantly increases fall risk in elderly patients - avoid routine use 3
• Can cause cognitive deficits, dry mouth, blurred vision, urinary retention 3, 2
• Lower doses required in elderly or those with hepatic/renal impairment 1

Prochlorperazine (For Severe Nausea/Vomiting)

• Dosing: 5 mg three times daily for acute symptoms, or 25 mg orally/suppository for severe cases (maximum 3 doses per 24 hours) 4, 5
• More effective than meclizine for associated nausea and vomiting 4, 5
• Not for primary vertigo treatment - reserved for managing autonomic symptoms 5

Critical warnings:

• Contraindicated with CNS depression or adrenergic blocker use 4, 5
• Significant side effects: hypotension, tachycardia, arrhythmias, akathisia, pseudo-parkinsonism, tardive dyskinesia, dystonia 4, 5
• QT prolongation with prolonged use 5
• Lower doses in elderly or hepatic/renal impairment 5

Benzodiazepines (Alternative for Acute Vertigo)

• Effective vestibular suppressants but carry significant dependence risk 4
• Reserved for severe acute episodes or psychogenic dizziness (panic disorder, anxiety) 6
• Not recommended for routine use due to fall risk and cognitive effects 4

Common Pitfalls to Avoid

1. Using meclizine as primary BPPV treatment - this delays definitive cure and prolongs symptoms unnecessarily 1, 3

2. Chronic vestibular suppressant use - interferes with central compensation and vestibular rehabilitation, prolonging recovery 3, 6

3. Prescribing to elderly without considering fall risk - anticholinergic burden and sedation significantly increase injury risk 3

4. Failing to reassess within 1 month - persistent symptoms require diagnostic reconsideration and medication discontinuation 3, 5

5. Ignoring medication side effects that worsen dizziness - many NSAIDs, narcotics, and other medications list dizziness as an adverse effect 4

When Medications Are NOT Indicated

• BPPV as primary treatment - repositioning maneuvers are definitively superior 1, 3
• Bilateral vestibular paresis - physical therapy only, no effective medications 6
• Chronic use for any vestibular disorder - prevents compensation and rehabilitation 3, 6
• Elderly patients with multiple comorbidities - unless severe symptoms justify the fall risk 3

Follow-Up Algorithm

• Reassess all patients within 1 month to document symptom resolution 3, 5
• If symptoms persist, reconsider diagnosis and discontinue vestibular suppressants 3
• Transition to vestibular rehabilitation therapy as soon as acute symptoms improve 3
• For Ménière's disease, implement dietary sodium restriction (<1500-2000 mg/day) and lifestyle modifications 4, 3