Meclizine Use and Subsequent Falls Among Patients with Dizziness

CLINICAL QUESTION

Does meclizine use after a new diagnosis of dizziness increase the risk of subsequent injurious falls?

BOTTOM LINE

Among the 805,454 adults diagnosed with dizziness, meclizine prescriptions were associated with a significantly increased risk of falls requiring medical care. This elevated fall risk was observed in both older adults (65 years and older) and adults aged 18–64 years, highlighting the need for caution in prescribing vestibular suppressants.

BACKGROUND: Meclizine is a widely used vestibular suppressant with anticholinergic properties that can cause sedation and impair balance. Despite guideline recommendations discouraging routine use—especially in older adults—prescribing remains common. Evidence directly linking meclizine use to fall events has been limited.

STUDY DESIGN: A retrospective cohort study using U.S. commercial and Medicare Advantage claims from 2006–2015. Adults aged 18 years and older with a new diagnosis of dizziness or vestibular disorder were included. Meclizine prescriptions within 30 days were assessed, and medically evaluated falls within 60 days of the prescription were analyzed. Multivariable models adjusted for demographic, clinical, and care-setting factors.

SETTING: National administrative claims database with linked medical, pharmacy, and socioeconomic information representing more than 200 million enrollees.

SYNOPSIS: The study evaluated 805,454 adults with dizziness. Overall, 8% received a meclizine prescription shortly after diagnosis. Use increased with age, and individuals with greater comorbidity and those presenting to the emergency department were more likely to receive meclizine. Following the prescription, 9% of users experienced a fall requiring medical care. Meclizine use was independently associated with a marked increase in fall risk. Adults aged 18–64 years had nearly a threefold increased risk, while those aged 65 years or older had more than a twofold increased risk. Higher comorbidity and initial presentation in the emergency department were also associated with increased fall risk. Patients with specific vestibular diagnoses were somewhat more likely to receive meclizine, but most prescriptions were issued for nonspecific dizziness. Limitations include reliance on claims data, which cannot distinguish medication adherence, over-the-counter use, dizziness severity, or falls that did not result in medical evaluation. Nonetheless, the analysis highlights broad use of meclizine and demonstrates a strong association between its prescription and subsequent falls across adult age groups.

CITATION: Adams ME, et al. Meclizine use and subsequent falls among patients with dizziness. JAMA Otolaryngol Head Neck Surg. 2025;151(9):861–867. doi: 10.1001/ jamaoto.2025.2052.

COMMENT: The article demonstrates that meclizine, when provided to individuals after a dizziness evaluation, is associated with a doubling of fall risk. Meclizine is the most commonly used antiemetic vestibular suppressant in the U.S., and it is prescribed not infrequently for causes of dizziness where extant guidelines recommend restricted use. While the research does not establish causality, it does suggest that clinicians would be wise to exercise caution in prescribing meclizine, provide appropriate counseling about fall risk, and consider nonpharmacological alternatives when possible.— Robert Hong, MD, PhD