Could an 86-year-old female patient's history of Covid-19 be contributing to her persistent dizziness when sitting up, despite taking meclizine (antihistamine) up to three times a day?

Persistent Dizziness in an 86-Year-Old Post-COVID Patient

Stop the scheduled meclizine immediately and use it only as-needed for severe symptoms, then pursue proper diagnostic evaluation for the underlying cause of her persistent positional dizziness, which may indeed be related to her COVID-19 infection.

Why Meclizine Is Not the Answer

Meclizine three times daily is inappropriate for persistent dizziness and may be causing more harm than good. The American Academy of Otolaryngology-Head and Neck Surgery explicitly recommends against routine treatment with vestibular suppressant medications like antihistamines for ongoing vertigo 1. These medications:

• Interfere with central vestibular compensation, preventing the brain from adapting to vestibular dysfunction 1
• Significantly increase fall risk in elderly patients, which is particularly dangerous at age 86 1
• Cause drowsiness, cognitive deficits, and impaired functioning 1
• Should only be used short-term (3-5 days maximum) for severe acute symptoms with nausea/vomiting, not as ongoing therapy 1, 2

The COVID-19 Connection Is Real

Yes, her prior COVID-19 infection could absolutely be contributing to her persistent dizziness. Long COVID commonly causes:

• Dizziness and balance issues as a major neurological manifestation 1
• Audiovestibular symptoms including vertigo, tinnitus, and hearing loss 1
• Postural Orthostatic Tachycardia Syndrome (POTS), which causes lightheadedness and dizziness upon standing, affecting 10-30% of COVID survivors 1, 3
• Autonomic dysfunction affecting balance and blood pressure regulation 1

POTS specifically presents with excessive heart rate increase (≥30 bpm) within 10 minutes of standing, along with dizziness, lightheadedness, weakness, and fatigue—symptoms that persist beyond sitting up 1, 3. Up to 40% of POTS cases are preceded by viral infections 1.

What You Should Do Instead

Immediate Actions:

1. Transition meclizine to PRN (as-needed) only for severe symptomatic episodes, not scheduled dosing 2
2. Measure orthostatic vital signs: Have her lie down for 5 minutes, then stand for 10 minutes while checking heart rate and blood pressure at baseline, 3 minutes, 5 minutes, and 10 minutes 1, 3
3. Document the specific pattern: Does dizziness occur only with position changes? Does it resolve when still, or persist? Is there true spinning (vertigo) or lightheadedness? 2

Diagnostic Evaluation Needed:

She requires proper assessment within 1 month to determine the underlying cause 1. This should include:

• Dix-Hallpike maneuver to evaluate for BPPV (benign paroxysmal positional vertigo), which is present in 40% of geriatric patients with dizziness and can be definitively treated with repositioning maneuvers 1
• Orthostatic vital signs testing for POTS or orthostatic hypotension 1, 3
• Medication review for polypharmacy contributing to dizziness or fall risk 1, 2
• Evaluation for other post-COVID sequelae 1

Appropriate Treatment Options:

If BPPV is diagnosed: Canalith repositioning procedures (Epley maneuver) are the definitive treatment, with significantly better outcomes than medication 1

If POTS is diagnosed: Management includes:

• Increased fluid and salt intake 1
• Compression stockings 1
• Gradual exercise reconditioning 1
• NOT vestibular suppressants 1

If vestibular rehabilitation is needed: Medications must be discontinued as they impede the compensation process 1, 2

Critical Safety Concerns for This Patient

At 86 years old, she faces compounded risks:

• Falls are a leading cause of morbidity and mortality in elderly patients with untreated vertigo 1
• Vestibular suppressants are an independent risk factor for falls, especially with polypharmacy 1
• Anticholinergic burden from meclizine contributes to cognitive decline, functional impairment, and decreased activities of daily living 1
• Persistent untreated vertigo leads to depression, decreased quality of life, increased caregiver burden, and risk of nursing home placement 1

The Bottom Line

Continuing meclizine three times daily is masking symptoms without addressing the cause, preventing natural compensation, and increasing her fall risk. She needs proper diagnosis—likely BPPV, post-COVID POTS, or another vestibular disorder—followed by appropriate treatment. If BPPV, a simple repositioning maneuver could resolve her symptoms entirely. If POTS, specific management strategies exist. But continuing antihistamines scheduled around the clock will only delay recovery and increase harm 1, 2.