Treatment of vertigo

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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



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


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




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


5 or 10 mg PO q4-6h

Stimulant, can counteract sedation of antihistamines, anxiety


25 mg PO q4-6h

Available without prescription


Diazepam (Valium)

5 or 10 mg PO q6-8h

Sedation, little effect on nausea


Prochlorperazine (Compazine)

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

Good antiemetic; extrapyramidal side effects, particularly in young patients

Classes and agents




Metoclopramide (Reglan)

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

Improves gastric emptying

References: See page 195.

References: See page 195.

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