Medication Management for PPPD
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.
Medications for Persistent Postural Perceptual Dizziness (PPPD): Helping you decide
This webpage will help you and your healthcare provider understand common medications for treating ongoing dizziness, including suggestions on how much you may need to take. While these medications are often used for anxiety and depression, studies show they may also help heal brain pathways that control movement and balance.
What is PPPD?
Persistent Postural-Perceptual Dizziness (PPPD) is a condition that causes persistent or ongoing sensations of dizziness or unsteadiness. Treatment options include the following:
- Physical or occupational therapy
- Counseling
- Certain medications
These treatments can be used individually or together. Research shows that proper treatment can reduce symptoms and improve daily functioning.
What do I need to know about medications for PPPD?
Studies show that many people who take medications experience symptom relief after 8–12 weeks of treatment.
- Many find relief with doses lower than half the typical approved range.
- No single medication is consistently more effective or better tolerated than others.
Medications used for new onset dizziness (like meclizine) usually are NOT effective for persistent dizziness.
Special Considerations:
- If you also have anxiety or depression, you might need a higher dose.
- If you also have migraines, Venlafaxine may help manage both migraines and dizziness.
Always talk with your healthcare provider for personalized advice and treatment options.
Side effects are common with any medication, but those listed below typically lessen over 4–6 weeks.
|
MEDICATION generic (brand name) |
STARTING DOSE mg = milligrams |
COMMON DOSE RANGE |
|
Selective Seratonin Reputake Inhibitors (SSRIs) |
||
| sertraline (Zoloft) | 25 mg daily | 50 to 150 mg daily |
| escitalopram (Lexapro) | 5 mg daily | 10 to 20 mg daily |
| fluoxetine (Prozac) | 10 mg daily | 20 to 60 mg daily |
|
Seratonin-Norepinephrine Reuptake Inhibitors (SNRIs) |
||
| venlafaxine ER (Effexor) | 37.5 mg daily | 75 to 225 mg daily |
| duloxetine (Cymbalta) | 20 to 30 mg daily | 40 to 60 mg daily |
|
Alternative |
||
| mirtazepine (Remeron) | 7.5 mg daily | 10 to 30 mg nightly |
Staab JP. Persistent Postural-Perceptual Dizziness. Seminars in Neurology 2020; 40(1), 130–137, www.thieme.com (reposted with permission).
Where can I learn more?
- Vestibular Disorders Association (VeDA): vestibular.org
- VeDA Treatments: vestibular.org/article/diagnosis-treatment/treatments/
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