Medications for Vertigo That Do Not Cause Glaucoma

Safe Medication Options for Vertigo in Glaucoma Patients

The American Academy of Otolaryngology-Head and Neck Surgery recommends meclizine as a first-line medication for patients with vertigo who have glaucoma or are at risk for glaucoma, as it does not significantly affect intraocular pressure while effectively managing vertigo symptoms 1, 2
Meclizine should be used primarily as-needed rather than scheduled to avoid interfering with vestibular compensation, according to the American Academy of Otolaryngology-Head and Neck Surgery 1, 2
Dimenhydrinate may have slightly more pronounced anticholinergic effects compared to meclizine, as noted by the American Academy of Otolaryngology-Head and Neck Surgery 1, 2

Betahistine should be avoided in glaucoma patients as it may potentially affect intraocular pressure, according to the American Academy of Otolaryngology-Head and Neck Surgery 2, 5
Carbonic anhydrase inhibitor diuretics should be avoided as they can affect intraocular pressure, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 2

For Benign Paroxysmal Positional Vertigo (BPPV), particle repositioning maneuvers (Epley, Semont) should be first-line treatment rather than medications, with a success rate of 78.6%-93.3% compared to 30.8% with medication alone, according to the American Academy of Otolaryngology-Head and Neck Surgery 4
For Ménière's Disease, meclizine can be used during acute attacks, and non-carbonic anhydrase inhibitor diuretics may be considered as maintenance therapy, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1, 2
Intratympanic steroid therapy may be offered to patients with Ménière's Disease who are not responsive to noninvasive treatments, according to the American Academy of Otolaryngology-Head and Neck Surgery 5, 2

All vestibular suppressant medications can cause drowsiness, cognitive deficits, and interference with driving, and are a significant independent risk factor for falls, especially in elderly patients, as noted by the American Academy of Otolaryngology-Head and Neck Surgery 4, 1
Patients should be reassessed within 1 month after initial treatment to document resolution or persistence of symptoms, and consideration should be given to titrating down or stopping medication once symptoms subside, according to the American Academy of Otolaryngology-Head and Neck Surgery 4, 2

Meclizine should be dosed at 12.5-25 mg every 4-6 hours as needed, not to exceed 100 mg daily, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1
Prochlorperazine should be used at a dose of 5-10 mg three to four times daily for short-term use only, according to the American Academy of Otolaryngology-Head and Neck Surgery 3
Benzodiazepines should be used at the lowest effective dose for the shortest duration possible, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 4, 1