I. See Also

II. General

  1. Evaluate and treat specific Vertigo Causes
  2. Medications are indicated for symptomatic acute Vertigo
  3. Avoid longstanding use of symptomatic medications
    1. Stop medications to allow brain to equilabrate
  4. Early ambulation improves rate of recovery
  5. Rehabilitation Exercises
    1. Epley Maneuver for BPPV
    2. Prescribed program of head movements and activity
      1. Improves symptom adaptation and balance
      2. Yardley (2004) Ann Intern Med 141:598-605

III. Management: Symptomatic Therapy - Outpatient

  1. Over the counter medications (Category B in pregnancy)
    1. Meclizine (Antivert)
      1. Age >12 years: 25 mg orally every 6 hours as needed
      2. Precaution: Sedating
    2. Dimenhydrinate (Dramamine)
      1. Adults: 50-100 mg PO q4-6 hours (max: 400 mg/day)
      2. Age 2-5: 12.5-25 mg PO q6-8 hours (max: 75 mg/day)
      3. Age 6-12: 25-50 mg PO q6-8 hours (max: 150 mg/day)
      4. Better Anti-emetic effect than Meclizine
      5. Less Sedation than Meclizine
  2. Benzodiazepines for severe symptoms (adult dosing)
    1. Diazepam (Valium) 5-10 mg PO q6 hours
    2. Lorazepam (Ativan) 0.5-2 mg PO q6 hours
  3. Antiemetics
    1. Metoclopramide (Reglan) 10 mg PO q6 hours

IV. Management: Symptomatic Therapy - Emergency Department

  1. Anti-Vertigo
    1. Dimenhydrinate (Dramamine) 50 mg IV q4 to 6 hours prn
    2. Lorazepam (Ativan) 0.5 to 2 mg IV q6 to 8 hours prn
  2. Antiemetics
    1. Promethazine (Phenergan)
    2. Prochlorperazine (Compazine)

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