Medication Summary
Several types of medications have been used to treat vestibular neuritis. Treatment generally has been based on responses of patients with motion sickness, a related condition. Few controlled studies exist; treatment is often empiric. The results from one trial suggest a 3-week course of methylprednisolone tapered from 100 mg down to 10 mg daily may reduce long-term loss of vestibular function. Despite the evidence of viral infection in at least some patients, valacyclovir was found not to be helpful alone or in combination with methylprednisolone in the same study. [17] Conversely, other small outpatient trials suggested possible enhancement of early recovery but no long-term benefit from a course of steroid therapy. [18, 19, 20, 21] A rigorous Cochrane review that included four trials found no significant difference in the symptomatic resolution of vertigo at 24 hours, and no clear benefit in long-term recovery, though the sparsity of high-quality data was noted. [22]
H1-receptor antagonists
Class Summary
These agents may suppress vestibular responses through an effect on the CNS, although their mechanism remains unknown. Some investigators believe this action is mediated primarily by central anticholinergic activity. Dimenhydrinate appears to be more effective and less sedating than lorazepam at the doses tested for the relief of acute vertigo. [23]
Dimenhydrinate (Dramamine, Dimetabs, Dymenate)
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.
Diphenhydramine (Benadryl, Bydramine, Hyrexin)
For treatment and prophylaxis of vestibular disorders that may cause nausea and vomiting.
Meclizine (Antivert)
Decreases excitability of middle ear labyrinth and blocks conduction in middle ear vestibular-cerebellar pathways. These effects associated with relief of nausea and vomiting.
Promethazine (Phenergan)
For symptomatic treatment of nausea in vestibular dysfunction.
Benzodiazepines
Class Summary
These agents centrally inhibit vestibular responses, presumably by potentiating inhibitory GABA receptors.
Diazepam (Valium, Diastat, Diazemuls)
Probably most commonly used benzodiazepine to treat vertigo, its CNS duration is relatively short as it is highly lipophilic and undergoes rapid redistribution after administration.
Lorazepam (Ativan)
Sedative hypnotic with short onset of effects and relatively long half-life. By increasing action of GABA, which is major inhibitory neurotransmitter in brain, may depress all levels of CNS, including limbic and reticular formation.
Anticholinergics
Class Summary
These agents are thought to work centrally by suppressing conduction in vestibular cerebellar pathways.
Scopolamine (Scopace, Transderm Scop)
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. Use in vestibular neuronitis limited by its slow onset of action.
Corticosteroids
Class Summary
Have anti-inflammatory properties and cause profound and varied metabolic effects. Modify the body's immune response to diverse stimuli.
Prednisone (Deltasone, Orasone)
Anti-inflammatory properties may reduce inflammation and edema of the vestibular nerve and associated apparatus, leading to faster recovery and less permanent damage.
