Medications for acute vertigo

Drug	Dose as-needed
Orally administered agents:
Antihistamines, first-generation
Dimenhydrinate	50 mg every 4 to 6 hours
Diphenhydramine	25 to 50 mg every 4 to 6 hours (maximum daily dose 200 to 300 mg)
Meclizine	12.5 to 50 mg every 6 to 12 hours (maximum daily dose 100 mg)
Benzodiazepines
Alprazolam	0.5 mg immediate release every 8 hours
Clonazepam	0.25 to 0.5 mg every 8 to 12 hours
Diazepam	1 to 5 mg every 12 hours
Lorazepam	1 to 2 mg every 8 hours
Benzodiazepines should not be used for more than 2 to 3 days for acute vertigo treatment
Antiemetics*
Metoclopramide	5 to 10 mg every 6 hours
Ondansetron^¶	4 mg every 8 to 12 hours
Prochlorperazine	5 to 10 mg every 6 hours
Promethazine	12.5 to 25 mg every 4 to 6 hours
Parenterally administered agents for acute emergency ward use:^Δ
Antihistamines, first-generation
Diphenhydramine	10 to 50 mg IV
Dimenhydrinate	50 mg IV
Antiemetics*
Metoclopramide	10 mg IV
Ondansetron^¶	4 to 8 mg IV
Prochlorperazine	2.5 to 10 mg IV
Promethazine	12.5 to 25 mg IM or IV (vesicant, use caution with IV administration; refer to Lexicomp drug monograph included within UpToDate)

Medications for treatment of acute vertigo. Doses listed are for non-volume depleted adult or adolescent patients with normal renal function. These agents may require dose adjustment in patients with reduced organ function (eg, kidney or cardiac disease) and in older persons. For specific recommendations, refer to the Lexicomp drug monographs included within UpToDate.

IV: intravenous; IM: intramuscular.

* Rare adverse cardiac reactions have been described with most antiemetics, particularly following parenteral use. These agents should be avoided in patients with known QT interval prolongation or other risk factors for torsades de pointes (TdP; eg, hypomagnesemia, hypokalemia). Refer to topic review of acquired long QT syndrome, section on drug-induced TdP within UpToDate. Phenothiazines and metoclopramide can cause extrapyramidal side effects (eg, akathisia, dystonia), particularly with parenteral use. Refer to accompanying text.

¶ Other serotonin 5HT3 antagonist antiemetics (eg, dolasetron, granisetron) may be used if ondansetron is not available.

Δ If IV access is unavailable, these agents may be administered IM. However, with the exception of promethazine, IM use is not preferred due to injection site pain.

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Medications for acute vertigo