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Dr. Andrew Rynne

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Suggest Bonine dose for treatment of vertigo

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Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 1662 Questions

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Posted on Thu, 14 Aug 2014 in General Health
Question: I have vertigo and have experienced it before. I am taking Bonine from the drug store What strength and how many can I take daily if the symptoms aren't getting much better.
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Answered by Dr. Dariush Saghafi 1 hour later
Brief Answer:
Meclizine is highly variable in treatment results

Detailed Answer:
Good day XXXX. My name is Dr. Saghafi and I am a neurologist. I would like to address your concern with a recommendation that I hope you find useful.

I understand you suffer from vertigo and that this is not the first time. You are also taking Bonine which is advertised to treat dizziness from motion sickness as well as nausea and vomiting caused by the same. You are taking 25 mg. twice daily.

I can tell you that if you have TRUE vertigo, that is to say the sensation of movement which is usually described as a whirling or spinning sensation then, I would highly recommend you NOT take this or any other medication until you've had a thorough examination by a doctor such as a neurologist who is well versed in these types of symptoms. Certain forms of vertigo are clearly benign and can be treated conservatively while others may represent impending serious problems including strokes, aneurysms, or other vascular malformations in the brain or the neck. It is not wise to simply take OTC medications without having things checked out first.

If your vertigo is that of a spinning sensation for example and if it seems to mostly or only occur at times when you change position from a lying to a standing or standing to lying status, and tends to settle down after 30-60 seconds, and even may cause a degree of nauseousness (usually not vomiting) then, you may be suffering from something we refer to as BENIGN PAROXYSMAL POSITIONAL VERTIGO. This condition can sometimes be treated with meclizine but in my practice I prefer asking patients perform certain head exercise maneuvers which tend to give quicker and more definitive relief called the Brandt-Daroff Exercises.

Medications are poorly effective for that form of vertigo since it is not easily quieted down by such weak over the counter preparations. Nor are prescription medications a good idea anyways since the strength of those preparations can induce other problems such as extreme fatigue, slurred speech, changes in mental status causing falls, falling asleep behind the wheel, and some are potentially addicting. So you see, medications are just not a good choice for such a form of vertigo.

If on the other hand your vertigo is not dependent on your head position and you seem to have it 24/7 no matter what you do or what position you hold with your head, etc. then, you may be suffering from a stroke or remnants of a stroke that may've affected either your brainstem or cerebellar hemispheres. It may also be a transient symptom reflective of blockages in what are referred to as your vertebral artery system found in the neck.

Neck adjustments by chiropractors are frequently recommended by friends, relatives (and of course, chiropractors). They are considered extremely dangerous by the XXXXXXX Academy of Neurology and the results from such maneuvers are generally poor since they do not treat the problem at hand which is loss of circulation to the back part of the brain where balance and equilibrium are controlled. In fact, there are scores and scores of cases in the literature of people going for neck adjustments and dying as a result. Bottom line, NO NECK ADJUSTMENTS please unless you are fully aware of these potential complications and willing to accept the seriousness of their consequences.

Finally, and possibly least likely of the possibilities you describe would be that of an infection of the inner ear sometimes referred to as a labrynthitis or viral labrynthitis. In these very isolated cases (which often times can never really be proven by any means) the use of medication such as BONINE may be indicated but even then, results are highly variable and so the risks/benefits of taking the drug must be weighed against simply letting the viral entity run its course, usually 7-10 days and then, people get back to normal.

I hope I've provided you with some insight as to why I believe you should really seek out the opinions of a neurologist (preferably) or at least a physician well versed in this sort of problem who will take the time to carefully ask the right questions and do a complete examination on you before making a decision on any form of medication. This is not as "easy" a problem to deal with as one may initially think and the consequences of being wrong can be devastating.

If you feel I've provided you with useful and timely information then, please respond with some written feedback including a "star rating" and I'd be very appreciative to take your comments under consideration for future discussions with you and others. I would also appreciate your CLOSING THIS QUERY if there are no further questions to pose as this will show that we have satisfactorily addressed and completed the questions you've posed.

Once again, the best to you and hope you get well soon.

This case discussion required 28 minutes of physician specific time in reviewing, researching, and compiling final draft documentation for envoy.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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