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).
The term vestibular labyrinthitis is not explicitly mentioned in the drug label. However, it can be inferred that meclizine may be used to treat vertigo associated with diseases affecting the vestibular system, which includes labyrinthitis.
- Key points:
- Meclizine is indicated for the treatment of vertigo associated with diseases affecting the vestibular system.
- Vestibular labyrinthitis is a condition that affects the vestibular system and can cause vertigo.
- Clinical decision: Meclizine may be used to treat vertigo associated with vestibular labyrinthitis, but the label does not directly support this indication 1.
From the Research
Vestibular labyrinthitis should be treated with oral prednisolone 50mg/d for 5 days with tapering of doses for the next 5 days, and possibly combined with initial intravenous betamethasone 8mg the first 1 to 2 days if the patient is nauseous, as early treatment within 24 hours of onset results in better restitution of vestibular function 2.
Treatment Approach
The treatment approach for vestibular labyrinthitis involves managing symptoms and supporting the body's recovery.
- Antivertigo medications like meclizine (Antivert) 25mg every 6-8 hours or dimenhydrinate (Dramamine) 50mg every 4-6 hours can help reduce dizziness.
- For severe nausea, ondansetron (Zofran) 4-8mg every 8 hours may be prescribed, as it has been shown to have a protective effect against vestibular deficit 3, 4.
- If a bacterial infection is suspected, antibiotics might be necessary.
- Vestibular rehabilitation exercises may help speed recovery by retraining the brain to compensate for inner ear changes.
Prognosis and Recovery
The prognosis for vestibular labyrinthitis varies, with some patients experiencing lingering symptoms for several months 5.
- Patients presenting with idiopathic labyrinthitis have a poor prognosis for both hearing and balance function impairment.
- Early treatment and vestibular rehabilitation can improve outcomes and reduce the risk of long-term disability.
- It is essential to stay hydrated, avoid sudden head movements, and gradually resume normal activities as symptoms improve.
Diagnosis and Evaluation
The diagnosis of vestibular labyrinthitis is based on the patient's history and physical examination, including orthostatic blood pressure measurement, a full cardiac and neurologic examination, assessment for nystagmus, and the Dix-Hallpike maneuver 6.
- The HINTS (head-impulse, nystagmus, test of skew) examination can help distinguish peripheral from central etiologies.
- Laboratory testing and imaging are not required and are usually not helpful.