Neurologic Manifestations of Benign Positional Vertigo Medication

Updated: Jul 23, 2018
  • Author: John C Li, MD; Chief Editor: Robert A Egan, MD  more...
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Medication

Medication Summary

Generally, medications are not recommended, as they do not seem to help. Supportive medications for vertigo include vestibulosuppressants and antiemetics. Several medications have antivertiginous properties (eg, meclizine, scopolamine, ephedrine, dimenhydrinate, diazepam) and others are useful as antiemetics (eg, promethazine, prochlorperazine). The majority of acute episodes are short-lived and self-limited.

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Antihistamines

Class Summary

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

Meclizine (Antivert, Antrizine, Meni-D)

Decreases excitability of middle ear labyrinth and blocks conduction in middle ear vestibular-cerebellar pathways. These effects are associated with therapeutic effects in relief of nausea and vomiting.

Dimenhydrinate (Dimetabs, Dramamine)

A 1:1 salt of 8 chlorotheophylline and diphenhydramine thought to be useful in 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.

Scopolamine (Isopto)

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

Transdermal scopolamine may be most effective agent for motion sickness. Its use in vestibular neuronitis is limited by its 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 GABA and facilitate inhibitory GABA neurotransmission and other inhibitory transmitters. These effects may prevent vertigo and emesis.

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 owing to effects in the dopaminergic mesolimbic system.

Promethazine (Phenergan)

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

Prochlorperazine (Compazine)

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

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Monoaminergics

Class Summary

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

Ephedrine (Pretz-D)

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

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