An elderly patient presents with room-spinning vertigo that worsens with rapid head movements and is accompanied by nausea; what is an appropriate treatment option?

• A. Meclizine
• B. Diazepam
• C. Metoclopramide
• D. Ondansetron

Answer: (A)

This scenario highlights a peripheral vertigo pattern that is often triggered by head movements, most classically BPPV. The goal here is to relieve vertigo symptoms while the underlying mechanism (displaced ear crystals) is addressed with positional maneuvers; when medication is used, the aim is to suppress vestibular input and nausea temporarily.

Meclizine is an antihistamine with anticholinergic properties that dampens input from the vestibular system to the brainstem. This reduces the spinning sensation and accompanying nausea, making it a practical choice for symptomatic relief in this setting, especially when a noninvasive maneuver isn’t immediately performed or while waiting for the maneuver to be implemented.

Diazepam could help with anxiety and provide some central suppression, but it carries higher risks in the elderly, including sedation, impaired coordination, and dependence, making it less favorable as a first-line choice for vertigo. Metoclopramide is an antiemetic that can provoke extrapyramidal symptoms in older adults and does not directly address the vertigo mechanism. Ondansetron treats nausea but not the vertigo itself.

So, given the goal of symptom control in an elderly patient with positional vertigo and nausea, meclizine is the best option among the choices.