CNS Causes of Vertigo Medication

  • Author: Marcelo B Antunes, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Apr 2, 2012
 

Medication Summary

The goal of pharmacotherapy is to reduce morbidity and prevent complications.

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Antihistamines

Class Summary

These agents prevent the histamine response in sensory nerve endings and blood vessels. They are also effective in treating vertigo.

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Meclizine (Antivert, Antrizine, Meni-D)

 

Decreases excitability of middle ear labyrinth and blocks conduction in middle ear vestibular-cerebellar pathways. This decrease is associated with therapeutic effects in the relief of nausea and vomiting.

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Dimenhydrinate (Dimetabs, Dramamine)

 

1:1 salt of 8-chlorotheophylline and diphenhydramine thought to be useful in the treatment of vertigo.

Diminishes vestibular stimulation and depresses labyrinthine function through central anticholinergic effects. However, prolonged treatment may decrease rate of recovery of vestibular injuries.

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Anticholinergics

Class Summary

These agents work centrally by suppressing conduction in the vestibular cerebellar pathways.

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Scopolamine (Isopto)

 

Blocks action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and the CNS. Antagonizes histamine and serotonin action.

Transdermal scopolamine may be most effective agent for motion sickness. Use in vestibular neuronitis is limited by slow onset of action.

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Benzodiazepines

Class Summary

By binding to specific receptor sites, these agents appear to potentiate the effects of γ -aminobutyric acid (GABA) and facilitate inhibitory GABA neurotransmission and other inhibitory transmitters. These effects may prevent vertigo and emesis.

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Diazepam (Valium)

 

Depresses all levels of CNS (eg, limbic and reticular formation), possibly by increasing activity of GABA.

Individualize dosage and increase cautiously to avoid adverse effects.

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Phenothiazines

Class Summary

These agents are effective in treating emesis, possibly because of effects in dopaminergic mesolimbic system.

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Promethazine (Phenergan)

 

For symptomatic treatment of nausea in vestibular dysfunction.

Antidopaminergic agent effective in treating emesis. Blocks postsynaptic mesolimbic dopaminergic receptors in brain and reduces stimuli to brainstem reticular system.

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Prochlorperazine (Compazine)

 

May relieve nausea and vomiting by depressing reticular activating system and blocking postsynaptic mesolimbic dopamine receptors through anticholinergic.

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Monoaminergics

Class Summary

These agents may treat vertigo, possibly through modulating the sympathetic system.

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Ephedrine (Pretz-D)

 

Stimulates release of epinephrine stores, producing alpha- and beta-adrenergic effects.

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Contributor Information and Disclosures
Author

Marcelo B Antunes, MD  Resident Physician, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System

Disclosure: Nothing to disclose.

Coauthor(s)

Michael J Ruckenstein  MD, MSc, Professor, Department of Otorhinolaryngology Head and Neck Surgery, University of Pennsylvania Health System

Michael J Ruckenstein is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

B Viswanatha, MBBS, MS, DLO  Professor of Otolaryngology (ENT), Chief of ENT III Unit, Sri Venkateshwara ENT Institute, Victoria Hospital, Bangalore Medical College and Research Institute; PG and UG Examiner, Manipal University, India and Annamalai University, India

B Viswanatha, MBBS, MS, DLO is a member of the following medical societies: Association of Otolaryngologists of India, Indian Medical Association, and Indian Society of Otology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Peter S Roland, MD  Professor, Department of Neurological Surgery, Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery, Director of Clinical Center for Auditory, Vestibular and Facial Nerve Disorders, Chief of Pediatric Otology, University of Texas Southwestern Medical Center; Adjunct Professor of Communicative Disorders, University of Texas School of Human Development

Peter S Roland, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Auditory Society, American Laryngological Rhinological and Otological Society, American Neurotology Society, American Otological Society, North American Skull Base Society, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Alcon Labs Honoraria Speaking and teaching; Advanced Bionics Honoraria Board membership; Cochlear Corp Honoraria Board membership; Med El Corp travel grants Consulting; Foresight Consulting fee Consulting

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Medvoy Ownership interest Management position; Cerescan Imaging Consulting; Headwatersmb Consulting fee Consulting; Venturequest Royalty Consulting

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Electrode montage for electronystagmography (ENG) testing.
 
 
 
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