Gordon H. Sun, MD, MS


April 20, 2017

Pharmacotherapy for BPPV

A study of patients referred to a tertiary balance clinic in Germany found that patients had attempted an average of 1.5 therapies for BPPV before being seen in the clinic, and that medications were used in 53.5% of cases.[8]

Vestibular suppressants and antiemetics are two classes of medications commonly used in the treatment of vertigo.[20] Benzodiazepines and antihistamines--major classes of vestibular suppressants—can reduce the subjective sensation of vertigo but interfere with central compensation in peripheral vestibular disorders.[1] Many of these medications have undesirable side effects, such as sedation, and a systematic review found that use of these medications was an independent risk factor for falls.[21] Antiemetics, a broad spectrum of drugs that includes 5-HT3 antagonists, phenothiazines, antihistamines, and other agents, also are associated with a variety of adverse side effects, such as decreased cognitive function, abnormal gastrointestinal motility, and dystonia.[1,20]

Various studies have demonstrated that CRP is superior to medications in the immediate treatment of BPPV.[22,23]

The AAO-HNSF recommends against routine use of pharmacologic treatment for BPPV.[1] However, in selected instances, medications could provide adjuvant benefit. For example, the combination of CRP and a benzodiazepine might be used to treat underlying psychological anxiety secondary to BPPV.[24] Other scenarios in which medication may be useful include patients who are severely symptomatic but refuse CRP, those who are severely symptomatic after CRP, and as prophylaxis before CRP in patients who demonstrate severe symptoms after Dix-Hallpike testing. The AAO-HNSF guideline notes that patients using vestibular suppressants should be advised about the risks for drug interactions, falls, driving and machinery-related accidents, and cognitive dysfunction.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: