What are some vestibular sedatives for treatment of vertigo (labyrinthine disorder)?

From the Guidelines

Benzodiazepines, such as diazepam and clonazepam, are effective labyrinthine sedatives for the treatment of vertigo, particularly for reducing the subjective sensation of spinning, as evidenced by the 2008 clinical practice guideline on benign paroxysmal positional vertigo 1. These medications have anxiolytic, sedative, muscle relaxant, and anticonvulsant properties, which can help alleviate vertigo symptoms. However, it is essential to note that they can interfere with central compensation in peripheral vestibular conditions, making them more suitable for short-term management.

Some key points to consider when using benzodiazepines for vertigo treatment include:

• They can be effective in reducing the spinning sensations of vertigo
• They may interfere with central compensation in peripheral vestibular conditions
• They should be used with caution and under medical supervision due to their potential for dependence and side effects
• Other medications, such as antihistamines (e.g., meclizine and diphenhydramine) and phenothiazines (e.g., promethazine), can also be used to treat vertigo and associated motion sickness symptoms, as discussed in the 2008 guideline 1.

In terms of specific dosing, diazepam can be prescribed at 2-5 mg doses taken 1-3 times daily, while clonazepam is typically taken at 0.5-1 mg doses 1-3 times daily. It is crucial to follow the prescribed dosage and to be aware of potential side effects, such as drowsiness, dry mouth, and blurred vision. Patients should avoid driving or operating machinery until they know how the medication affects them.

Overall, the choice of labyrinthine sedative for vertigo treatment should be individualized and based on the underlying cause of the vertigo, as well as the patient's medical history and current symptoms, as recommended in the 2008 clinical practice guideline 1.

From the FDA Drug Label

MECLIZINE HYDROCHLORIDE tablets, for oral use Initial U. S. Approval: 1957 INDICATIONS AND USAGE 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).

Labyrinthine sedatives for the treatment of vertigo include:

• Meclizine, which is indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults 2 It is a sedating medication that may cause drowsiness, and patients should use caution when driving or operating machinery.

From the Research

Labyrinthine Sedatives for Treatment of Vertigo

Some labyrinthine sedatives used for the treatment of vertigo include:

• Diazepam 3, 4
• Meclizine 3
• Cinnarizine 5
• Dimenhydrinate 5, 4

Efficacy of Labyrinthine Sedatives

Studies have shown that:

• Diazepam and meclizine are equally effective in the treatment of vertigo 3
• A fixed combination of cinnarizine and dimenhydrinate is more effective than monotherapy with either component in the treatment of acute vestibular vertigo 5
• Diazepam has antimotion sickness properties, with maximum effect obtained at 120 min 4

Surgical Treatment of Vestibular Vertigo

Surgical treatment of vestibular vertigo may be indicated in cases of severe impairment and lack of response to medication, with success rates varying depending on the procedure:

• Function-preserving therapies have a success rate of 70-88% 6
• Ablative procedures are effective in >90% of cases 6
• Occlusion of the superior or posterior canals is successful in >95% of patients 6
• Transmastoid labyrinthectomy and transcanal labyrinthectomy are viable options for the treatment of disabling vertigo in older patients, with episodic vertigo controlled in 95.5-100% of patients 7