Symptomatic treatment of acute vertigo
Only use symptomatic treatment for acute vertigo for a short time, while nausea is a problem (usually up to 48 hours). To treat the symptoms of acute vertigo due to vestibular neuritis or other vestibular disorders (eg Ménière disease, vestibular migraine), first-line therapy is prochlorperazine or promethazine.
If the patient has nausea but is not vomiting, use:
1 prochlorperazine 5 to 10 mg orally, 6- to 8-hourly for up to 2 days vertigo, acute prochlorperazine
OR
1 promethazine 25 to 50 mg orally, 8- to 12-hourly for up to 2 days (maximum daily dose 100 mg). vertigo, acute promethazine
If the patient has nausea but is not vomiting, and prochlorperazine or promethazine is not effective or tolerated, use:
1 diazepam 5 mg orally, 3 times daily for up to 2 days vertigo, acute diazepam
OR
1 ondansetron 4 to 8 mg orally, 2 to 3 times daily for up to 2 days1. vertigo, acute ondansetron
If the patient is vomiting, use:
1 prochlorperazine 12.5 mg intramuscularly, immediately, followed in 6 hours by 5 to 10 mg orally, as a single dose if needed prochlorperazine
OR
1 promethazine 10 to 25 mg intramuscularly or by slow intravenous infusion, then 10 to 25 mg orally or intramuscularly or by slow intravenous infusion, 8- to 12-hourly promethazine
OR
2 ondansetron 4 to 8 mg intramuscularly or by slow intravenous injection, 8- to 12-hourly. ondansetron
Do not continue symptomatic treatment of chronic dizziness or vertigo with these drugs long term, because of the risk of tardive dyskinesia, drug-induced parkinsonism or dependence.