Many of us get dizzy occasionally. “Dizzy” means different things to different people. It may be weakness or lightheadedness at times. Most often, it is vertigo: a sense that the room is spinning or that you are spinning.
Historically, doctors have prescribed meclizine (brand name Antivert), a sedating antihistamine, to treat vertigo. While it is FDA-approved for this purpose, it is not always a good choice.
The commonest cause of vertigo is a shift of tiny stones in the middle ear (“otoliths”) into the wrong position. This causes BPV: benign positional vertigo. It typically comes on with a change of position. You feel as if you just got off a merry-go-round when all you did is get out of bed or lie down. [Note – the vertigo can come with any change in position – lying down or turning to one side may trigger it as well as getting up.]
Weakness or wooziness without the sense of spinning when getting up is NOT BPV, but more likely a drop in blood pressure resulting in less blood getting to the brain.
The treatment of BPV is a maneuver that moves the head to get the otoliths back into the right place. It can be done by a physician, nurse or physical therapist who know how, and usually cures the problem. Pills, with their side effects, have no place in treating this condition.
Meniere’s disease is a recurrent vertigo, usually accompanied by hearing loss and/or ringing in the ears that comes for no reason. Here meclizine may be helpful, but should only be used for the acute attacks, not on a prolonged basis.
Acute labyrinthitis comes on suddenly and can be severely disabling, making walking almost impossible. It is due to inflammation of the nerve to the inner ear. It can be accompanied by hearing loss, and if it is, is an emergency, requiring steroids to prevent permanent deafness. Sometimes the vertigo is so severe that the hearing loss is overlooked.
Meclizine can be used for a few days to help the troubling dizziness of labrynthitis, with the understanding that it is treating symptoms that are going to pass on their own. It is not curing the condition.
Why not use meclizine more freely?
A recent study looked at people who had been diagnosed with vertigo who were or were not prescribed meclizine. Those prescribed meclizine had almost three times as many falls resulting in emergency department visits as those who were not.
Add that to the concern that sedating antihistamines contribute to confusion, and it is clear. Meclizine may help with troubling vertigo, but it should be used in as low a dose and for as short a time as possible.
Finally – a warning. The new onset of vertigo that lasts for more than half an hour can be a stroke, and demands immediate evaluation.
Edward Hoffer MD is Associate Professor of Medicine, part-time, at Harvard.
What Does The Doctor Say?
By Dr. Edward Hoffer