Is meclizine (Antivert) effective for Benign Paroxysmal Positional Vertigo (BPPV) in a 90-year-old male?

From the Guidelines

Meclizine should not be used as a primary treatment for benign paroxysmal positional vertigo (BPPV) in a 90-year-old male, as the evidence suggests that vestibular suppressant medications are not effective in treating BPPV and may even cause harm, particularly in the elderly population. According to the clinical practice guideline: benign paroxysmal positional vertigo (update) 1, there is no evidence to suggest that vestibular suppressant medications, such as meclizine, are effective in treating BPPV. In fact, the guideline recommends against the routine use of these medications for BPPV, citing the potential for significant harm, including drowsiness, cognitive deficits, and increased risk of falls.

Instead, canalith repositioning maneuvers, such as the Epley maneuver, should be considered as the primary treatment for BPPV. These physical maneuvers have been shown to be highly effective in resolving BPPV symptoms and are recommended as the first-line treatment by the clinical practice guideline 1. The guideline also recommends that patients with BPPV be counseled regarding the impact of BPPV on their safety, the potential for disease recurrence, and the importance of follow-up 1.

In terms of medication use, meclizine may be considered for short-term management of autonomic symptoms, such as nausea or vomiting, in a severely symptomatic patient. However, its use should be limited to the shortest duration possible, and patients should be closely monitored for potential side effects, including drowsiness, dry mouth, and urinary retention 1. Additionally, patients and their caregivers should be cautioned about the potential risks of meclizine, including increased fall risk and confusion, particularly in elderly patients.

Some key points to consider when treating BPPV in a 90-year-old male include:

• The importance of diagnosing BPPV accurately, using tests such as the Dix-Hallpike maneuver or supine roll test 1
• The need to differentiate BPPV from other causes of imbalance, dizziness, and vertigo 1
• The potential for BPPV to recur, and the importance of counseling patients regarding this risk and the need for follow-up 1
• The importance of monitoring patients closely for potential side effects of medication use, particularly in the elderly population 1

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). Recommended dosage: 25 mg to 100 mg daily, in divided doses (2.1).

Meclizine can be used for the treatment of vertigo associated with diseases affecting the vestibular system, such as BPPV, in a 90-year-old male. The recommended dosage is 25 mg to 100 mg daily, in divided doses 2. However, it is essential to exercise caution due to potential adverse reactions, such as drowsiness, and drug interactions, particularly with other CNS depressants, including alcohol 2.

• Key considerations:
  • Dosing: 25 mg to 100 mg daily, in divided doses
  • Potential adverse reactions: drowsiness, dry mouth, headache, fatigue, and vomiting
  • Drug interactions: CNS depressants, including alcohol, and CYP2D6 inhibitors
  • Contraindications: hypersensitivity to meclizine or any of the inactive ingredients 2.

From the Research

Treatment of BPPV

• The Epley manoeuvre is a safe and effective treatment for posterior canal BPPV, with a high success rate 3, 4, 5.
• The choice of manoeuvre depends on the clinician's preferences, failure of previous manoeuvres, or movement restrictions of the patient 6.
• Meclizine is not recommended as a treatment for BPPV, as it has little therapeutic effect and can have side effects 7.

Patient Characteristics

• The studies included patients of various ages, including a 90-year-old male, with no specific age-related restrictions for the Epley manoeuvre 3, 5.
• Patients with BPPV can be treated in primary care or specialist otolaryngology clinics 3, 5.

Treatment Outcomes

• The Epley manoeuvre has been shown to have a high success rate, with complete resolution of vertigo symptoms in 56% of patients compared to 21% with sham manoeuvres or controls 3.
• The manoeuvre is also effective in converting a positive Dix-Hallpike test to a negative test, with an odds ratio of 9.62 3.
• Adverse effects of the Epley manoeuvre are infrequent and usually mild, with no serious adverse effects reported 3, 4.