Overview of Drug Therapy for Dizziness

The page at /home/jcbalanc/dizziness-and-balance.com/practice/drugrx.html provides a detailed, clinically oriented review of medications used to treat dizziness, vertigo, and balance disorders. It is written for healthcare professionals and informed patients. Key medication categories include vestibular suppressants, antiemetics, and specific drugs for conditions like Meniere’s disease or vestibular migraine.

Core Drug Categories

• Antihistamines: Meclizine (Antivert), dimenhydrinate (Dramamine), and diphenhydramine. These are first-line for acute vertigo but not for long-term use.
• Benzodiazepines: Diazepam (Valium), lorazepam (Ativan), clonazepam (Klonopin). Used for vestibular suppression and anxiety related to dizziness. Risk of dependence and falls.
• Antiemetics: Ondansetron (Zofran), promethazine (Phenergan), metoclopramide (Reglan). Control nausea and vomiting from vertigo.
• Diuretics: Hydrochlorothiazide (HCTZ) or acetazolamide (Diamox). Used for Meniere’s disease to reduce endolymphatic pressure.
• Betahistine: Not FDA approved in the US but used elsewhere for Meniere’s disease. Placebo-controlled evidence is mixed.
• Antidepressants: SSRIs (e.g., sertraline, fluoxetine) or SNRIs (e.g., venlafaxine). First-line for vestibular migraine and chronic subjective dizziness (CSD / PPPD).
• Calcium channel blockers: Verapamil, flunarizine (not US). Used for vestibular migraine prevention.

Clinical Pearls

The resource emphasizes:

• Avoid long-term use of vestibular suppressants (e.g., meclizine) because they delay central compensation after a vestibular injury.
• Benzodiazepines should be used cautiously due to fall risk and tolerance.
• For Meniere’s disease, a low-sodium diet plus diuretics is the mainstay; betahistine is controversial.
• Vestibular migraine often responds well to lifestyle changes and migraine preventive medications (beta blockers, tricyclics, or anti-CGRP agents).
• PPPD (persistent postural-perceptual dizziness) is treated with SSRIs/SNRIs, vestibular rehabilitation, and cognitive behavioral therapy.

Safety & Monitoring

Always consider drug interactions, side effects (sedation, dry mouth, urinary retention, QT prolongation), and the patient’s age and comorbidities. The page advises baseline labs (e.g., electrolytes, renal function) for diuretics, and slow dose titration for antidepressants. Avoid driving or operating machinery while on sedating medications.

Drugs to Avoid

Certain medications can worsen dizziness or cause imbalance: aminoglycoside antibiotics (ototoxic), loop diuretics (ototoxic), and some antiepileptics (e.g., phenytoin, carbamazepine at high levels). The page recommends checking for ototoxic exposures in any patient with new or worsening dizziness.