Association Between Meclizine Prescription and 90-Day Readmissions for Trauma and for Dizziness

Dizziness is a common chief complaint in emergency departments, accounting for millions of visits annually in the United States. While the etiology is frequently benign, inappropriate management can lead to recurrent presentations and increased risk of complications such as falls. Meclizine, an antihistamine vestibular suppressant, is often prescribed for dizziness despite limited evidence supporting its efficacy, particularly for conditions such as benign paroxysmal positional vertigo (BPPV). Furthermore, it may increase the risk of falls due to its sedative and anticholinergic effects, particularly in older adults. SAEM’s Grace Guidelines recommend against routine use of meclizine. We sought to examine whether meclizine prescription during dizziness encounters is associated with 90-day readmissions for trauma, falls, or accidents. Secondarily, we assessed whether it is associated with subsequent dizziness readmissions.

We performed a retrospective cohort study of adult patients presenting with primary diagnosis of dizziness or vertigo at Texas hospitals from 2022–2024. Using negative binomial regression, we analyzed the association between meclizine prescription and the number of 90-day readmissions for trauma and for dizziness, adjusting for age, sex, race, and payer status. Results are presented as incidence rate ratios (IRRs) with 95% confidence intervals (CIs).

Among 45,866 encounters, the median age was 55 years (IQR 38–69). Most encounters were female (63.2%) and white (55.7). Meclizine was prescribed in 32.2% of encounters. Patients prescribed meclizine had 2.94 times higher expected rates of trauma-related readmissions within 90 days compared to those not prescribed meclizine (95% CI: 1.72–5.09). Furthermore, meclizine prescribees had 1.4 times higher expected rates of dizziness-related readmissions (95% CI: 1.31–1.60).

Meclizine prescription was associated with significantly higher 90-day readmission rates for trauma and even for dizziness per se. These findings suggest that meclizine may not only increase fall risk but may also even worsen dizziness itself. Caution should be exercised when prescribing meclizine for dizziness, and non-pharmacologic management strategies such as canalith repositioning maneuvers should be prioritized.