Medication Management for PPPD

Persistent postural perceptual dizziness (PPPD) is a medical condition that can cause a persistent feeling of dizziness or unsteadiness. PPPD 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 PPPD 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 PPPD, 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.

REFERENCES:

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.