ENT/Vestibular sedative / antiemetic

Drugs for vertigo (Ménière / vestibular)

also: prochlorperazine · betahistine · cinnarizine · cyclizine

Overview

Symptomatic relief of acute vertigo, and prophylaxis in Ménière disease. Vestibular sedatives are for the ACUTE phase only — they delay central compensation if continued.

Mechanism

Prochlorperazine (D₂ antagonist, also antiemetic) and antihistamines (cinnarizine, cyclizine) suppress vestibular and chemoreceptor-trigger-zone activity → relieve acute vertigo/nausea. Betahistine is a histamine analogue thought to improve inner-ear microcirculation → reduces frequency of Ménière attacks.

Indications

Acute vertigo / vestibular neuronitis (short-term)
Ménière disease (betahistine for prophylaxis)
Motion sickness (cinnarizine/hyoscine)

The agents

ProchlorperazineD₂ antagonist

oral/buccal/IM

Acute vertigo; can cause extrapyramidal effects.

Cinnarizine / cyclizineantihistamine

Acute vertigo, motion sickness.

Betahistinehistamine analogue

oral

Ménière PROPHYLAXIS (not acute).

Adverse effects

Sedation, drowsinesscommon

Prochlorperazine: extrapyramidal reactions (dystonia, parkinsonism)serious

Delayed vestibular compensation if used beyond the acute phaseclassic

Stop vestibular sedatives after a few days.

Cautions & contraindications

Prolonged use for chronic vertigoall

Prevents central compensation.

Prochlorperazine in Parkinson diseaseall

D₂ blockade worsens it.

Betahistine caution in asthma / peptic ulcerasthma

Interactions

Additive sedation; prochlorperazine + other dopamine antagonists → EPSEs

Monitoring & kinetics

Symptom resolution; stop sedatives early

Oral/buccal/IM. Vestibular sedatives short-term; betahistine longer-term for Ménière.

Source: NICE CKS — Vertigo / Ménière · BNF — Vertigo & Ménière