Oral Medications for Acute Relief
Acute attacks of vertigo associated with Ménière's disease can be treated with benzodiazepines, antiemetic, or anticholinergic medications. Alleviation of symptoms is achieved through different physiologic pathways, based on the drug category prescribed. If a patient reports typical symptoms of Ménière's disease but has not undergone audiometry, the plausible diagnosis may lead to tentative treatment for acute episodes if other causes of vertigo have been ruled out.
Antihistamines, such as meclizine or dimenhydrinate, may help reduce vertigo symptoms and associated nausea by blocking the effects of histamine. One of the most common side effects of antihistamines is drowsiness, so patients must be cautioned to avoid certain activities while taking this medication. Antihistamines should not be given to patients with glaucoma or prostate disease due to the potentially strong anticholinergic effects of these drugs.
Scopolamine is a belladonna alkaloid that can be applied topically on the tissue just behind the ear to help reduce nausea and vomiting related to vertigo.
Another option for treatment of acute vertigo is a benzodiazepine, such as alprazolam, to suppress active cerebellar responses; this agent may also reduce anxiety associated with an acute episode of vertigo. Benzodiazepines should be started at the lowest dose and increased as needed to the maximum recommended for individual medications based on symptom relief and side effects. Although caution needs to be used when prescribing benzodiazepines, studies show that they can be effective for persons with Meniere's disease.
Other antiemetic medications, such as promethazine or ondansetron, may be needed to treat severe nausea, but these agents should be used cautiously with other medications due a potential side effect of sedation.