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There are differential effects across benzodiazepines on Gaba-A receptor subtypes. Addiction, impaired memory, increased risk of falling, and possibly impaired vestibular compensation are their main shortcomings.
Lorazepam and klonazepam are particularly useful agents because of their effectiveness and simple kinetics.
It is to be hoped that agents selective for vestibular subtypes of muscarinic receptors will eventually be developed or discovered among our presently available pharmacopoeia, as these agents may provide vestibular suppression with less side effects. This has been described for scopolamine (Luetje and Wooten 1996), and other anticholinergics may also have addiction syndromes. All the antihistamines in general use for control of vertigo also have anticholinergic activity.
Withdrawal has been described from a similar agent to meclizine, diphenhydramine. With the possible exception of astemizole (Hismanal) in Meniere's disease (Turner and Jackson, 1989), antihistamines that do not cross the blood brain barrier, are not used to control vertigo.
Cholinergic agonists that cross into the brain, such as physostigmine, can cause a motion-sickness syndrome (Soto et al, 2013).
Scopolamine and atropine are nonspecific muscarinic receptor antagonists (Barton et al, 1994; Soto et al, 2013).
We also highly recommend the neuropharmacology review article written by Soto et al (2013).
A discussion of drug treatment should start with a discussion of the neurotransmitters used to signal in the vestibular system. Vestibular suppressant and antiemetic drugs are the mainstay of treatment of vertigo.
Unfortunately, astemizole does not appear to be generally useful as it is ineffective in preventing motion sickness (Kohl et al, 1987) and because it has significant potential toxicity.
There is evidence for involvement of several types of histamine receptors.
Long acting benzodiazepines are not helpful for relief of vertigo.