Treatment of vertigo

A. A vestibular exercise program should be instituted as soon as possible.

While nystagmus is present, patients should attempt to focus the eyes and should move and hold them in the direction that provokes the most dizziness. When nystagmus has diminished to the point that the patient can clearly focus on a target in all directions, eye-head coordination exercises should be started. A useful exercise is to stare at a target while oscillating the head from side to side and up and down.

Treatment of Vertigo

Cause

Treatment

Benign positional vertigo

Acute unilateral

Chronic bilateral

Maneuver to remove debris from semicircular canal

Antivertiginous drugs for first few days; vestibular rehabilitation

Discontinuation of ototoxic agent; vestibular rehabilitation

Meniere's disease

Low-salt diet (1-2 g sodium daily) with diuretic; antivertiginous drugs; surgery in intractable cases

Migraine

Control of potential triggers (eg, foods, stress); antimigraine drugs (beta blockers)

Vertebrobasilar insufficiency

Antiplatelet drug (aspirin or ticlopidine); anticoagulant (heparin or warfarin [Coumadin]) if spells continue

Antivertiginous and Antiemetic Drugs

Classes and agents

Dosage

Comments

Antihistamines

Dimenhydrinate (Benadryl)

50 mg PO q4-6h or 100-mg supp. q8h

Available without prescription, mild sedation, minimal side effects

Meclizine (Antivert)

25-50 mg PO q4-6h

Mild sedation, minimal side effects

Promethazine (Phenergan)

25-50 mg PO, IM, or suppository q4-6h

Good for nausea, vertigo, more sedation, extrapyramidal effects

Monoaminergic agents

Amphetamine

5 or 10 mg PO q4-6h

Stimulant, can counteract sedation of antihistamines, anxiety

Ephedrine

25 mg PO q4-6h

Available without prescription

Benzodiazepine

Diazepam (Valium)

5 or 10 mg PO q6-8h

Sedation, little effect on nausea

Phenothiazine

Prochlorperazine (Compazine)

5-25 mg PO, IM, or suppository q4-6h

Good antiemetic; extrapyramidal side effects, particularly in young patients

Classes and agents

Dosage

Comments

Benzamide

Metoclopramide (Reglan)

5-10 mg PO, IM, or IV q4-6h

Improves gastric emptying

References: See page 195.

References: See page 195.

Natural Vertigo And Dizziness Relief

Natural Vertigo And Dizziness Relief

Are you sick of feeling like the whole world Is spinning out of control. Do You Feel Weak Helpless Nauseous? Are You Scared to Move More Than a Few Inches From The Safety of Your Bed! Then you really need to read this page. You see, I know exactly what you are going through right now, believe me, I understand because I have been there & experienced vertigo at it's worst!

Get My Free Ebook


Post a comment