From the Guidelines
Medications for Meniere's disease should prioritize diuretics, such as hydrochlorothiazide (25-50 mg daily) or acetazolamide, to reduce fluid buildup in the inner ear, and vestibular suppressants like meclizine (25 mg every 4-6 hours as needed) for acute vertigo attacks, as recommended by the 2020 clinical practice guideline 1. The goal of treatment is to manage symptoms and improve quality of life, with a focus on reducing vertigo, hearing loss, tinnitus, and fullness in the ear. Some key points to consider in treatment include:
- Diet restrictions, such as a low-sodium diet (1500-2300 mg daily), to help decrease symptoms 1
- Limiting alcohol and caffeine intake to reduce symptom triggers 1
- Using medications like betahistine (16 mg three times daily) to improve inner ear blood flow, although it is not FDA-approved in the US 1
- Considering noninvasive therapies, such as vestibular rehabilitation and hearing aids, to help manage symptoms 1
- In some cases, steroid injections into the middle ear or gentamicin injections may be considered for patients who do not respond to standard treatments 1. It is essential to individualize treatment based on symptom severity and frequency, with medication adjustments made over time to find the most effective regimen with minimal side effects, as supported by the 2020 clinical practice guideline 1. Key considerations in treatment decisions include the potential benefits and harms of each treatment option, as well as the patient's overall health and quality of life, with the goal of minimizing morbidity, mortality, and improving quality of life.
From the FDA Drug Label
MECLIZINE The FDA drug label does not answer the question.
From the Research
Medications for Meniere's Disease
- Diuretics, such as hydrochlorothiazide, are recommended as a first-line conservative medical treatment for Meniere's disease, as they may help improve vertigo outcomes 2, 3
- Betahistine is also recommended as a first-line treatment, and its efficacy has been demonstrated in double-blind, randomized, placebo-controlled studies 2, 4
- Intratympanic injection of steroids is recommended as a second-line treatment when medical treatment fails 2
- Intratympanic injection of gentamicin is associated with a high probability of achieving complete vertigo control, but may be detrimental to hearing preservation 5
Combination Therapies
- Combining betahistine with the MAO-B inhibitor selegiline may allow for a lower dosage of betahistine to be effective in reducing the frequency of acute attacks of vertigo 6
- The combination of intratympanic steroid and high-dose betahistine may be associated with the largest difference in hearing improvement compared to placebo, and may also be effective in achieving complete vertigo control 5
Treatment Outcomes
- Improvement in vertigo episode frequency is consistently reported with diuretic therapy, with less convincing evidence for improvement in hearing outcomes 3
- Betahistine has been shown to be effective in reducing the frequency of vertigo attacks, and may also have a positive effect on hearing outcomes 4, 5
- Intratympanic injection of gentamicin is associated with a high probability of achieving complete vertigo control, but may be detrimental to hearing preservation 5