Meclizine Use Linked To Higher Fall Risk In Adults With Dizziness, Study Finds

A large-scale study published this week in JAMA Otolaryngology–Head & Neck Surgery has found that meclizine, a commonly prescribed medication for dizziness and vertigo, is associated with a significantly increased risk of injurious falls in both older and younger adults. The findings raise concerns about the routine use of this vestibular suppressant across care settings and age groups.

Meclizine, a first-generation antihistamine with anticholinergic properties, is widely used in the U.S. for short-term relief of dizziness symptoms. While it may offer temporary benefit in certain acute vestibular conditions, its adverse effects—such as sedation and impaired balance—have long prompted caution, particularly in older adults.

Until now, however, the direct association between meclizine use and fall-related injury had not been quantified in a nationally representative population.

Large Cohort Study Reveals Elevated Risk Across All Age Groups

In this retrospective cohort study, researchers analyzed insurance claims data from over 800,000 adults with new dizziness diagnoses between 2006 and 2015. Among these individuals, 8% filled a meclizine prescription within 30 days of diagnosis, and of those, 9% experienced a fall requiring medical attention within 60 days.

When adjusting for factors such as comorbidities, diagnosis specificity, and site of care, the study found that meclizine use was associated with a 2.94-fold increased risk of falls in adults aged 18 to 64 and a 2.54-fold increased risk in those aged 65 and older.

“This study found that although meclizine may offer immediate vertigo relief, use is incongruent with guideline-concordant care for common vestibular diagnoses,” the authors wrote. “Receipt of a meclizine prescription was associated with an increased risk of injurious falls among both patients aged 65 years or older and those aged 18 to 64 years with dizziness, who are already fall prone.”

Fall risk was found to be particularly elevated in patients with multiple comorbidities or those presenting to emergency departments (EDs), where clinicians were more likely to initiate meclizine therapy. The researchers noted that while older adults are generally the focus of fall prevention efforts, the nearly threefold increased risk among younger adults challenges assumptions about age-based risk.

“Individuals aged 18 to 64 years have been underrepresented in fall research, and these findings suggest that meclizine may be overused and may potentially contribute to fall risk among patients with dizziness across the adult lifespan,” the researchers stated.

Overuse Despite Limited Long-Term Benefit

Although meclizine may be appropriate for short-term relief in acute cases like vestibular neuritis or labyrinthitis, clinical guidelines advise against its long-term use. The American Geriatrics Society’s Beers Criteria and Choosing Wisely recommendations have long discouraged the routine use of highly anticholinergic medications in older adults due to fall risk.

Despite these guidelines, the study found that meclizine was frequently prescribed for patients with nonspecific dizziness—before a clear diagnosis had been established. 

“Even though individuals with a specific vestibular diagnosis were twice as likely to receive meclizine…74% of prescriptions were filled by individuals with nonspecific dizziness diagnoses.”

This trend may reflect a broader issue in dizziness care: the tendency to prioritize symptom management over accurate diagnosis. “When symptom management is prioritized over efforts to establish a correct diagnosis, patients may end up taking vestibular suppressants long term, experiencing not only adverse effects and complications but also delays in receiving disease-specific treatment,” the authors noted, referencing previous commentary from Edlow et al.

Implications for Clinical Practice and Future Research

The findings underscore the importance of re-evaluating prescribing practices for dizziness and highlight the need for clinician awareness of meclizine’s risks—even in younger adults. The authors suggest that even when short-term use is deemed appropriate, clinicians should incorporate fall risk counseling at the time of prescription.

“This work is hypothesis generating and we cannot draw causal inferences,” the authors wrote.

“Pending this work, clinicians may be wise to exercise caution when prescribing meclizine to patients aged 18 to 64 years as well as those aged 65 years or older, to provide appropriate counseling about fall risk, and to consider nonpharmacological alternatives whenever possible.”

Non-drug interventions, such as canalith repositioning maneuvers for benign paroxysmal positional vertigo (BPPV) and physical therapy, have demonstrated effectiveness for many common vestibular disorders and pose fewer risks than pharmacologic approaches.

The study also raises questions about disparities in meclizine use and fall outcomes by race and ethnicity. Researchers found that Asian, Black, and Hispanic patients were more likely than White patients to receive meclizine, but had a lower likelihood of documented fall events. The authors caution that these observations may reflect differences in healthcare access or fall reporting and warrant further investigation.

Limitations of the study include its reliance on claims data, which may miss falls that do not result in medical encounters or fail to capture over-the-counter use of meclizine. The study also focused solely on meclizine, although other vestibular suppressants, such as benzodiazepines, may carry similar risks.

Nonetheless, the researchers emphasize the strength of the large, longitudinal cohort and its ability to identify population-level trends and risks not previously captured in smaller studies.

Preventing Fall Injuries

While meclizine remains a commonly used vestibular suppressant, this new evidence suggests that its routine prescription may contribute to preventable fall injuries in adults of all ages. The study’s findings support more cautious prescribing and greater emphasis on accurate diagnosis and nonpharmacologic treatment of dizziness.

“Future prospective and mechanistic studies may further elucidate the relationship between vestibular suppressants and fall risk,” the authors concluded, “and future guidelines that engage clinicians and patients to de-implement routine vestibular suppressant use for dizziness may be warranted.”

_{Reference:
Adams ME, Karaca-Mandic P, Marmor S. Meclizine Use and Subsequent Falls Among Patients With Dizziness. JAMA Otolaryngol Head Neck Surg. Published online July 24, 2025. doi:10.1001/jamaoto.2025.2052}

Source: JAMA Otolaryngology 

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