Gabapentin Does Not Worsen Ménière's Disease
There is no evidence that gabapentin exacerbates Ménière's disease symptoms, and it is not mentioned in the comprehensive 2020 American Academy of Otolaryngology-Head and Neck Surgery clinical practice guideline for Ménière's disease management. 1
Evidence Review
Gabapentin and Ménière's Disease
The 2020 AAO-HNS clinical practice guideline for Ménière's disease extensively reviews oral medications including betahistine, diuretics, oral steroids, antivirals, and benzodiazepines, but does not mention gabapentin as either a treatment option or a medication that worsens the condition. 1
Historical treatments for Ménière's disease symptoms have included vestibular suppressants, benzodiazepines for acute attacks, diuretics, histaminergic agents, and corticosteroids for bilateral forms, but gabapentin has not been part of the standard therapeutic armamentarium. 2, 3, 4, 5
Gabapentin's Role in Vestibular Disorders
Gabapentin has actually demonstrated benefit in certain vestibular conditions. In patients with periodic vestibulocerebellar ataxia (episodic ataxia type 4), low-dose gabapentin (100-200 mg TID) effectively relieved optokinetic-triggered vertigo, with patients reporting 8-12 hours of sustained relief after the first 100 mg dose. 6
The mechanism involves gabapentin's tight binding to Purkinje cell voltage-gated calcium channels, which can improve target tracking on smooth pursuit and stabilize gaze hold. 6
Important Distinction: Gabapentin and Migraine
While gabapentin is not recommended for migraine prevention (the 2024 VA/DoD guideline suggests against its use for episodic migraine prevention due to lack of efficacy in reducing monthly migraine days), 1 this is unrelated to Ménière's disease.
This distinction matters because Ménière's disease and migraine can co-occur at high rates, but the evidence against gabapentin for migraine does not translate to concerns about worsening Ménière's disease. 3
Clinical Bottom Line
Gabapentin can be safely used in patients with Ménière's disease when indicated for other conditions (such as neuropathic pain). There is no evidence suggesting it worsens vertigo attacks, hearing loss, tinnitus, or aural fullness characteristic of Ménière's disease. 1
The primary concern with gabapentin in any patient population is its common side effects of sedation and lower extremity edema, 1 not disease-specific exacerbation of Ménière's symptoms.