CNS Causes of Vertigo Medication

Updated: May 03, 2017
  • Author: Marcelo B Antunes, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Medication

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.

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.

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.

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.

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.

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.

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.

Ephedrine (Pretz-D)

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

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