From the Guidelines
Benzodiazepines, such as diazepam and clonazepam, are the most effective labyrinthine sedatives for the treatment of vertigo, due to their anxiolytic, sedative, and muscle relaxant properties. These medications can reduce the subjective sensation of spinning and are commonly used to treat vertigo 1.
Key Points to Consider
- The symptoms of vertigo can be treated with medications that reduce the spinning sensations or accompanying motion sickness symptoms, such as nausea and vomiting.
- Vestibular suppressant medications, including benzodiazepines and antihistamines, are commonly used to treat vertigo.
- Benzodiazepines, such as diazepam and clonazepam, have anxiolytic, sedative, muscle relaxant, and anticonvulsant properties, making them effective for reducing the sensation of spinning.
- Antihistamines, such as meclizine and diphenhydramine, can also be used to treat vertigo, particularly for associated motion sickness symptoms.
- Other medications, such as promethazine and scopolamine, can be used to treat motion sickness symptoms.
Medication Options
- Diazepam (Valium) at 2-5mg every 6-8 hours
- Clonazepam at 0.5-1mg every 8-12 hours
- Meclizine (Antivert) at 12.5-25mg every 4-6 hours
- Diphenhydramine at 25-50mg every 4-6 hours
- Promethazine (Phenergan) at 25mg every 6 hours
Important Considerations
- These medications should be used for short periods (3-5 days) as prolonged use can delay central compensation mechanisms that help the brain adjust to vestibular imbalance 1.
- Side effects commonly include drowsiness, dry mouth, and blurred vision, so patients should avoid driving or operating machinery while taking these medications.
- For recurrent or chronic vertigo, vestibular rehabilitation therapy is often more beneficial than long-term medication use.
From the FDA Drug Label
Meclizine hydrochloride tablets are indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults (1). May cause drowsiness: Use caution when driving a car or operating dangerous machinery (5. 1). Some labyrinthine sedatives for the treatment of vertigo include:
- Meclizine 2, which can cause drowsiness as a common adverse reaction. It is essential to use caution when driving or operating machinery due to the potential for CNS depression when coadministered with other CNS depressants, including alcohol 2.
From the Research
Labyrinthine Sedatives for Treatment of Vertigo
- The following sedatives have been studied for the treatment of vertigo:
- Diazepam: a benzodiazepine that has been shown to be effective in treating vertigo, particularly in cases of acute peripheral vertigo 3, 4
- Meclizine: an antihistamine that has been shown to be effective in treating vertigo, particularly in cases of acute peripheral vertigo 3
- Cinnarizine: a calcium channel blocker that has been shown to be effective in treating vertigo, particularly when used in combination with dimenhydrinate 5
- Dimenhydrinate: an antihistamine that has been shown to be effective in treating vertigo, particularly when used in combination with cinnarizine 5
- Betahistine: a histamine analog that has been shown to be effective in treating vertigo, particularly in cases of benign paroxysmal positional vertigo 6
- Flunarizine: a calcium channel blocker that has been shown to be effective in treating vertigo, particularly in cases of benign paroxysmal positional vertigo 6
Combination Therapies
- Combination therapies, such as cinnarizine and dimenhydrinate, have been shown to be effective in treating vertigo, particularly in cases of acute vestibular vertigo 5
- The addition of labyrinthine sedatives, such as betahistine and flunarizine, to Epley's manoeuvre has been shown to be effective in treating benign paroxysmal positional vertigo 6
Surgical Treatment
- Surgical treatment, such as tympanostomy tubes and endolymphatic shunt operation, may be indicated in cases of severe impairment and lack of response to medication 7