Long-Term Oral Medication
Medication for long-term management of Ménière's disease can promote improvement in symptoms and reduce the frequency of vertigo episodes. A mild diuretic, such as hydrochlorothiazide with or without triamterene, taken on a regular basis reduces extracellular fluids and may decrease pressure from endolymphatic hydrops. While strong evidence regarding the efficacy of diuretics is lacking, the majority of patients with Ménière's disease who are treated with diuretics do experience improvement in vertigo.
Betahistine hydrochloride, a vasodilator and histamine receptor antagonist, is another medication to consider for management of Ménière's disease. This agent is not approved by the FDA; however, the FDA classifies betahistine as an inert chemical, so it is available in compounding pharmacies in the United States. The efficacy of betahistine has not been clearly or consistently established in research studies, but it has been and continues to be widely used to treat Ménière's disease in Europe, with good results. Betahistine affects the microcirculation in the inner ear and inhibits the vestibular nuclei, which may reduce the frequency of vertigo episodes and improve tinnitus associated with Ménière's disease.