Adults who were prescribed meclizine following a dizziness diagnosis were significantly more likely to experience a fall requiring medical attention within 60 days, according to a cohort study of 805,454 US patients.
Although older adults are commonly considered at higher fall risk, the researchers found that younger adults aged 18 to 64 years also experienced a marked increase in fall incidence following meclizine use. Specifically in this study, adults aged 65 years and older and participants aged 18 to 64 who were prescribed meclizine were 2.5 times and nearly 3 times more likely, respectively, to have a fall recorded than those who were not prescribed meclizine.
Falls occurred in 9% of patients who filled a meclizine prescription within 30 days of a new dizziness diagnosis. “These findings underscore the need for caution in meclizine prescribing practices even among those aged 18 to 64 years, who may have previously been thought to be at lower risk,” wrote Meredith E. Adams, MD, (Department of Otolaryngology–Head and Neck Surgery, University of Michigan) and colleagues.
Researchers used diagnosis codes to identify injurious falls, including fractures and contusions, and adjusted for multiple confounders such as age, sex, comorbidity burden, and care setting. Among patients who were prescribed meclizine, 50% were aged 75 years or older. Women and patients who identified as Asian or Black were more likely to receive a prescription than White patients.
Patients with specific vestibular diagnoses such as benign paroxysmal positional vertigo or vestibular neuritis were more likely to be prescribed meclizine than those with nonspecific dizziness, but most prescriptions (74%) were issued before a definitive cause for dizziness was identified.
Meclizine prescriptions were also more common among patients who were seen in emergency departments than outpatient clinics, and patients with higher comorbidity scores were more both likely to receive the drug and to experience falls. These prescribing patterns raise concerns about polypharmacy and drug interactions, particularly among older adults and those who are already at elevated fall risk and may delay definitive diagnosis and expose patients to avoidable risks.
"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," investigators noted.
Limitations of the study include reliance on administrative claims, which may underreport nonmedical falls or overattribute injuries to falls using diagnostic codes. The analysis captured prescription fills but not adherence, dosage, or use of over-the-counter formulations. The study was also not designed to assess causality or long-term outcomes.
Future research could help clarify the mechanisms by which vestibular suppressants affect fall risk and to explore safer alternatives.
Disclosures can be found in the study.
