Let’s spend a few weeks talking about meclizine. Most patients complaining of dizziness or vertigo have been given a prescription for meclizine at some point. For a medication that is so widely used, there is very little solid information or recent research to back this up.

Meclizine goes by a few names; meclizine is the generic term, but it is also packaged under the names Antivert, Bonine, and Dramamine II. The original Dramamine (I guess we will call it Dramamine I) is a similar medication called Dimenhydrinate. Dramamine II is marketed as the “less drowsy” formula, although I am unaware of any studies to substantiate that claim. In fact one study showed that dimenhydrinate caused drowsiness for a shorter period of time than did meclizine.

So many patients come in to our balance clinic having received a prescription for meclizine, I am in the habit of asking them about perceived benefit. After listening to their symptoms (some of which include vertigo, nausea or motion sickness, but just as many do not), I ask them “What is it that the meclizine is treating?” The most common answer is ‘the dizziness.’ Most do not have a clear understanding of the purpose or potential benefit or negative effects of taking meclizine.

Most patients nod their head in agreement if I comment that they probably would not have come to my clinic if the meclizine resolved their symptoms. Most agree that the only thing they noticed was that the meclizine made them sleepy. Most are surprised when I tell them that meclizine does not actually treat inner ear disease, that it won’t keep them for getting dizzy, lightheaded or off balance, and they won’t get better any faster by taking it.

According to Drugs.com, the mechanism of action is described as:

“Antiemetic; antivertigo agent—The mechanism by which meclizine exerts its antiemetic, anti–motion sickness, and antivertigo effects is not precisely known but may be related to its central anticholinergic actions. It diminishes vestibular stimulation and depresses labyrinthine function. An action on the medullary chemoreceptive trigger zone may also be involved in the antiemetic effect.”

That doesn’t sound very convincing to me.

A recent 2012 study out of Belgium does support that meclizine probably has a sedating effect on the gain of the vestibular-ocular reflex, suspected to be a ‘central action on the medial vestibular nucleus’.

So, how shall we interpret that information as it relates to someone complaining of dizziness? First, and I have talked about this at length on this blog, you have to be more specific in your complaints. The term “dizziness” is very vague and can mean many different things. Some complaints of dizziness can be helped by a temporary prescription of meclizine, many won’t be affected at all, and some could be made worse.

Basically, if your inner ear is making you sick, and by sick I mean nauseous, then there is a role for meclizine. It will help relieve the temporary but acute vertigo and nausea associated with a few specific inner ear conditions such as Meniere’s disease or vestibular neuritis. It will also help relieve the nausea associated with motion sickness. It does this by reducing the information received by the brain from the inner ear. In an acute inner ear disease situation, what is making you spin and sick is the brain trying to resolve the conflict between a healthy ear and an unhealthy ear sending different signals to the brain. The brain would rather receive no information from the inner ears than to receive conflicting information.

As we have recently discussed with motion sickness, reducing the information from the inner ear reduces the conflict between vestibular and visual information. So, in these two situations, meclizine can be helpful.

Next week, I am going to recycle an article that I wrote many years ago with my colleague, Dr. Brian Collie. Dr. Collie is an ENT specialist and a registered pharmacist. It is about 15 years old and is no longer available on the web, so I hope you find it interesting. I will update the article where it is needed.

9 Responses to Let’s Talk About Meclizine

  1. JOSEPH CAPUTO says:

    I HAVE SEVERE VERTIGO ALTHOUGH I DO NOT VOMIT I NEVER DID MECLIZINE BONINE ALL THESE PILLS ARE GARBAGE THEY DONT DO ANYTHING THING AT ALL BUT MAKE YOU VERY VERY SLEEPY WITH A HANGOVER THE NEXT DAY. THEY REALLY SHOULD HAVE ANOTHER G EDICATION FOR THIS I HAVE BEEN SUFFERING WITH VERTIGO A LONG TIME, EVEN BENADRYL DOES NOT WORK…..JOEY CAPUTO….

  2. Wendy says:

    I have taken this medication off and on for over a year. In May of 2012 I fell to the floor with total loss of bodily functions. The day before I was completely normal and enjoying a bright sunny day with family. I now have 85% hearing loss in my left ear and tinnitus that is debilitating. The meclizine made me sleepy but did nothing for any other symptoms. I am diagnosed with Vestibular Equilibrium Disorder but the most frustrating issue for me is why this happened. The tinnitus never goes away and I fall down when I least expect it. I wish there was a Dr that could give me some kind of reason. I am losing my hearing in my right ear slowly and dealing with depression because before this happened I had a great quality of life. My quality of life has taken a extreme turn. I do not have crystals in my ear and the Drs seem baffled. I can no longer go so many places I used to be able to go including the grocery store. I am told that Neurologists are having trouble with this illness. I hope others that are suffering with this VED have as good as a family as I do, without them I would be lost. All my best to all that suffer with VED

  3. Cheryl says:

    I have found that Meclizine does help when the crystals break loose in my ears.. It helps with the spinning when I change positions in bed……………

  4. Nancy Hale Bishop says:

    I have suffered with motion sickness all my life. Meclizine has helped me survive many cruises and car trips. When I first came down with Vestibular Neuritis, I was prescribed Meclizine in the ER along with several other medications. A return trip a week later and they told me to double all the dosages. Finally, online, I found the information to stop those medications to allow my body to learn to compensate. I now am back to using Meclizine only for cruises. Unlike others, this does not make me drowsy at all. But . . . still waiting for the compensation to kick in.

  5. cathie says:

    I use meclizine for persistent nausea. Zero effect on dizziness or vertigo.

  6. Joe says:

    It is just a tool to help people with inner ear disorders and diseases survive an attack of vertigo and nausea. It is like taking aspirin when arthritis is acting up. It is not a cure but, it helps you survive to live another day. Most people who use it know this. Indeed, most people soon figure out it is best used as little as possible. Only preceding bad attacks (often only in suppository form as the pill will often not work fast enough before you barf it up – attacks can come that fast and sudden). After an attack is over or subsiding (a day, a week, a month, it depends on the victim of the disease and how bad they have it) it is best to lay off it and let your brain and body learn what it can do with the balance mechanism that remains. Drugs inhibit that process so, eventually and as soon as you feel you can, you need to rehabilitate the mechanism.

  7. Deb Zentz says:

    Having Ménière’s disease since 2006 have tried Bonine and all it does is make me sleepy for two days! I normally just use my Valium and ride out the storm! Thanks for the article!

  8. Deb B. says:

    I take Travel Sickness Meclizine HCI 100 Chwbls for my severe dizziness and it has been my only salvation in this mysterious disorder. Since it is chewable, I find relief within 5 minutes and can function once again. I have taken Meclizine as Antivert and it never helped, just caused drowsiness as noted. Reducing the communication between visual and vestibular makes perfect sense on why it works.

  9. theresa says:

    I do take meclizine to help with my motion sickness. This article was very interesting to me,thanks