Vertigo, dizziness, and gait imbalance due to peripheral and/or central vestibular disorders often have a significant impact on the patient’s quality of life. Falls and fall-related injuries, impaired vision due to oscillopsia, and secondary anxiety/panic attacks are only a few examples of conditions that need the treating physician’s attention. In this setting, often a combination of drug treatments and non-pharmaceutical interventions such as physical therapy or cognitive behavioral therapy is required. In this chapter, the focus is on pharmacotherapy in various neuro-otologic disorders, including peripheral-vestibular disorders such as acute unilateral vestibulopathy, Menière’s disease, and vestibular paroxysmia, and central vestibular disorders such as hereditary ataxias, vestibular migraine, and persistent postural-perceptual dizziness. This will include off-label drug treatment recommendations for various nystagmus patterns based on current evidence and a critical discussion of knowledge gaps.