From the Guidelines
For the treatment of vertigo, benzodiazepines such as diazepam and antihistamines like meclizine are commonly used as labyrinthine sedatives. These medications can help reduce the symptoms of vertigo by suppressing the vestibular system's activity. According to the study by 1, benzodiazepines have anxiolytic, sedative, muscle relaxant, and anticonvulsant properties, while antihistamines appear to have a suppressive effect on the central emetic center to relieve nausea and vomiting associated with motion sickness.
Some key points to consider when using these medications include:
- Benzodiazepines like diazepam can reduce the subjective sensation of spinning, but may interfere with central compensation in peripheral vestibular conditions 1.
- Antihistamines like meclizine and diphenhydramine can relieve nausea and vomiting associated with motion sickness, but may have side effects like drowsiness and dry mouth.
- Other medications like promethazine, a phenothiazine with antihistamine properties, and ondansetron, a serotonin-5-hydroxytryptamine-3 antagonist, can also be used to treat motion sickness symptoms.
- Anticholinergic medications like scopolamine can help reduce neural mismatching and alleviate motion sickness symptoms.
It's essential to note that these medications are most effective for acute episodes of vertigo rather than long-term use, as prolonged use can interfere with the brain's natural compensation mechanisms 1. Treatment typically lasts 3-5 days for acute episodes, after which gradual tapering is recommended to allow natural vestibular compensation to occur. Patients should also be advised to avoid driving or operating machinery while taking these medications due to potential side effects like drowsiness and blurred vision.
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
- 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