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Medication Management for 3PD

DISCLAIMER: This is an educational site for patients, caregivers, and medical providers. This information was accurate as of the date presented. Consult local medical authority or your healthcare provider for specific advice and referrals.

Medication Management for Persistent Postural Perceptual Dizziness (PPPD or 3PD)

Persistent postural perceptual dizziness is a medical condition that can cause a persistent feeling of dizziness or unsteadiness. 3PD has been found to be responsive to three main treatments:

  • These treatments include specific balance therapy, counseling, and medications. Treatments can be used alone or together, with research showing overall sustained reduction or resolution in 3PD symptoms and disability with proper treatment.
  • This fact sheet is to educate on common medications used and suggested therapeutic dose range, as outlined in published literature (1,2). Literature supports these medications as generally well-tolerated, with 85% of patients who completed an 8-12-week trial showing reduction in symptoms from impairing to not impairing. Most were responsive to doses in the lower half of approved dose range with no one medication appearing to be more/less effective or better tolerated.
  • Therapeutic dose range applies to uncomplicated cases of 3PD, where patients with coexisting anxiety or depressive disorders may need higher doses. There is also some evidence, in cases of migraine, Venlaflaxine may be more effective. The rationale for the medications is to help to open neurological pathways for healing.
  Initial Does Therapeutic Dose Range
Sertraline/Zoloft 25 mg daily 50–150 mg daily
Escitalopram/Lexapro 5 mg daily 10–20 mg daily
Fluoxetine/Prozac 10 mg daily 20–60 mg daily
Venlafaxine ER/Effexor 37.5 mg daily 75–225 mg daily
Duloxetine/Cymbalta 20–30 mg daily 40–60 mg daily
Mirtazapine/Remeron 7.5 mg nightly 10–30 mg nightly


  1. Staab JP. Persistent Postural-Perceptual Dizziness. Seminars in Neurology. 2020. Doi 10.1055/s-0039-34027362.
  2. Staab JP. Chronic subjective dizziness. Continuum (Minneapolis, MN). 2012; 18 (5 Neuro-otology): 1118–1141.

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