From the Guidelines
The most effective treatment for dizziness is to address its underlying cause, and for vertigo caused by inner ear problems, a limited course of vestibular suppressants such as meclizine (Antivert) 25mg every 6-8 hours or dimenhydrinate (Dramamine) 50mg every 4-6 hours can provide relief, as recommended by the 2020 clinical practice guideline for Ménière's disease 1. The treatment approach for dizziness depends on the underlying cause, which can range from inner ear problems to low blood pressure or anxiety-related issues.
- For vertigo caused by inner ear problems, medications like meclizine (Antivert) or dimenhydrinate (Dramamine) can provide relief, as stated in the 2020 guideline for Ménière's disease 1.
- For BPPV (Benign Paroxysmal Positional Vertigo), the Epley maneuver performed by a healthcare provider can reposition inner ear crystals, as recommended by the 2017 clinical practice guideline for BPPV 1.
- If dizziness stems from low blood pressure, increasing fluid and salt intake, wearing compression stockings, or medications like fludrocortisone may help.
- For anxiety-related dizziness, anti-anxiety medications or cognitive behavioral therapy might be recommended.
- Vestibular rehabilitation exercises can improve balance for chronic dizziness, and it's essential to stay hydrated, avoid sudden movements, rise slowly from sitting or lying positions, and avoid triggers like caffeine or alcohol. The 2020 guideline for Ménière's disease recommends offering a limited course of vestibular suppressants to patients for management of vertigo only during Ménière’s disease attacks, based on nonrandomized or historically controlled studies, including case-control and observational studies, and a preponderance of benefit over harm 1. In contrast, the 2017 guideline for BPPV recommends against routine treatment with vestibular suppressant medications such as antihistamines and/or benzodiazepines 1. However, the most recent and highest quality study, the 2020 guideline for Ménière's disease, prioritizes the use of vestibular suppressants for vertigo management 1. Therefore, the treatment for dizziness should prioritize addressing the underlying cause and using vestibular suppressants as needed, while also considering the patient's quality of life and potential benefits and harms of treatment, as emphasized in the 2020 guideline for Ménière's disease 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. Recommended dosage: 25 mg to 100 mg daily, in divided doses. The medical treatment for dizziness (specifically vertigo) is meclizine with a recommended dosage of 25 mg to 100 mg daily, in divided doses 2.
- Key points:
- Meclizine is used to treat vertigo associated with diseases affecting the vestibular system in adults.
- The recommended dosage is 25 mg to 100 mg daily, in divided doses.
From the Research
Medical Treatment for Dizziness
The medical treatment for dizziness depends on the underlying cause of the symptoms. According to 3, treatment options include:
- Canalith repositioning procedures, such as the Epley maneuver, for benign paroxysmal positional vertigo
- Vestibular rehabilitation for peripheral and central etiologies
- Specific treatment to address the cause of dizziness, such as pharmacologic intervention for certain conditions
Pharmacologic Intervention
Pharmacologic intervention is limited due to its potential to affect the central nervous system's ability to compensate for dizziness 3. However, vestibular suppressant medications may be used to relieve symptoms of vestibular neuritis 4. Nevertheless, the use of vestibular suppressants, such as meclizine and benzodiazepines, is not recommended as a routine treatment for dizziness in older adults due to the increased risk of falls 5.
Alternative Treatment Options
Alternative treatment options for dizziness include:
- Vestibular physiotherapy and rehabilitation 6, 7
- Ergotherapy and rehabilitation 7
- Surgical interventions for certain conditions, such as Meniere's disease 7
- Clinical approaches, such as repositioning maneuvers, for benign paroxysmal positional vertigo 7
Treatment Recommendations
Treatment recommendations for dizziness vary depending on the underlying cause and may include a combination of the above-mentioned options. According to 7, treatment should be tailored to the specific cause of dizziness and may involve medication, vestibular physiotherapy, and other interventions. It is essential to note that the treatment of dizziness should be individualized and based on a thorough history and physical examination 3, 4, 6.