Clinical reference

Acute vestibular neuritis & labyrinthitis

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

Egyptian National Drug Formulary - Nervous System Disorders 2025 · Dimenhydrinate 50 mg tablets US OTC drug facts label (DailyMed, Time Cap Labs) · Smith T, Rider J, Cen S, Borger J. Vestibular Neuronitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Last Update: July 21, 2023. Bookshelf ID: NBK549866, PMID: 31751056.

Verified against2 documents

Egyptian National Drug Formulary - Nervous System Disorders 2025
Dimenhydrinate 50 mg tablets US OTC drug facts label (DailyMed, Time Cap Labs)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (6)

Nausea, vomiting and severe spinning vertigo are the commonest complaints [nausea · vertigo · vomiting]
Pin down how many true spinning attacks there have been; general unsteadiness or lightheadedness does not fit [unsteadiness]
The peak of vertigo seldom lasts beyond 72 hours, though unsteadiness and brief spells can run for weeks [unsteadiness · vertigo]
Recovery drags on where anxiety or depression sits alongside [anxiety · low mood]
Ask about a recent viral upper respiratory infection
Ask about cholesteatoma, past ear surgery, temporal bone fracture, meningitis and otitis media

Signs — what you find (5)

Nystagmus is usually there, with the fast phase beating away from the affected ear [nystagmus]
Gait and balance are often off, so test Romberg, tandem gait, cerebellar and meningeal signs
Rinne and Weber will usually show sensorineural loss on the affected side, so arrange formal audiology
Otoscopy may reveal the cause, such as otitis media or cholesteatoma
If bacterial meningitis is on the cards, check the skin for a non-blanching rash [purpura · rash]

Tests (9)

Labyrinthitis is a diagnosis of exclusion
Audiometry establishes whether sensorineural hearing loss is present and how severe
Specialist vestibular tests have no role acutely; they help later with compensation and residual deficit
Severe vomiting warrants a basic metabolic panel for electrolytes and hydration
Analyse the cerebrospinal fluid if bacterial meningitis is suspected
HIV and syphilis serology help in high-risk patients or an atypical picture
Consider autoimmune testing where there are systemic features, even if the titres come back negative
MRI or CT is there to pick up an alternative diagnosis
Image the cerebellopontine angle when the ears differ by more than 15 dB, as 13% of acoustic neuromas start as sudden hearing loss

If not this — what else fits (12)

Vestibular neuritis looks the same but arrives without hearing loss
Meniere disease also gives hearing loss with vertigo, but the attacks come and go
Meniere disease is marked by fluctuating fullness in the ear, tinnitus and hearing loss with the spells
BPPV gives dizziness with no hearing loss and an abnormal Dix-Hallpike test
A stroke at the back of the brain shows abnormal neurology: ataxia, hoarseness, slurred speech or trouble swallowing
Vertigo with cranial nerve deficits, tract signs or numbness suggests a brainstem stroke
Acoustic neuroma is diagnosed on gadolinium-enhanced MRI
Inner ear malformations give progressive or congenital hearing loss, seen on CT or MRI
A temporal bone fracture follows a recent head injury and is diagnosed on CT
Bleeding into the inner ear usually follows trauma and shows on MRI
A temporal bone tumour usually brings cranial nerve deficits or facial palsy, seen on MRI or CT
Multiple sclerosis carries other features such as spasticity, optic neuritis or cranial nerve deficits

SourceStatPearls "Labyrinthitis" - disease-level clinical article

Presentation findings are traced to the source above.

DIMENHYDRINATE

1st line

Strength50 mg

Formoral.solid

Adult dose and duration

50 mg 3-4 times daily as needed for acute severe vertiginous nausea (max 3 days continuous use)

Paediatric dose

Age restriction: minimum 24 months

(children 6 to under 12 years: give 1/2 to 1 tablet every 6-8 hours; do not give more than 3 tablets in 24 hours. children 2 to under 6 years: give 1/2 tablet every 6-8 hours; do not give more than 1 1/2 tablets in 24 hours.)

Dose by age
2 to under 6 years:	Half a tablet every 6 to 8 hours, and no more than one and a half tablets in 24 hours
6 to under 12 years:	Half to one tablet every 6 to 8 hours, and no more than 3 tablets in 24 hours

Dose source

Dimenhydrinate 50 mg tablets US OTC drug facts label (DailyMed, Time Cap Labs)

Why

Short-term antiemetic vestibular suppressant strictly limited to initial 48-72 hours so as not to impair central compensation

Cautions

Sedation and anticholinergic effects (dry mouth, urinary retention) can occur.
Never above 400 mg in 24 hours.
Alcohol, sedatives and tranquillisers all deepen the drowsiness. No driving until they know how it takes them.
Ask twice before giving it in glaucoma, prostatic enlargement with difficulty passing urine, or chronic lung disease - it is an anticholinergic antihistamine and all three get worse.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
DRAMENEX 50MG 20 TABS.	KAHIRA	28.00 EGP (1.40/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.