Medications for Meniere's Disease

The following is a list of the medications that I have taken or still take for Meniere's Disease, including prescription, over-the-counter, vitamins, and herbals. I have never taken anything without my ENT doctor's approval. I include the medication name and what I think it's supposed to do, observations about effectiveness and side effects, and whether or not I plan to continue taking it.

Dramamine / Bromine / Antivert

These are common over-the-counter medications usually given for nausea and motion sickness. Dramamine and Bromine/Antivert are different chemicals but are similar in nature and apparently related to the drug in Benadryl. They are also usually given to people suffering from vertigo, particularly when nausea and vomiting is experienced. They are not to be taken regularly but rather only in the case of acute symptoms. I took both (not together) during the early stages of Meniere's. I do not believe that they helped me, and did not feel a difference when I stopped taking them. They make you drowsy, which actually might be a good thing early on. If I had been severely nauseated or vomiting, I likely would tell a different story about them. Considering that most of the improvement that Meniere's sufferers experience likely comes from the body's gradual adaptation to dizziness, it is actually detrimental to take these medications over the long term if they mask the vertigo symptoms. The body must experience vertigo in order to overcome it.

SERC / Betahistine

This is an anti-vertigo drug specifically for Meniere's and other balance disorder patients. It has been around since at least the early 1970s. I had read on several Meniere's forums a few personal accounts of the miraculous effects of this drug. Several people reported the total elimination of their dizziness after taking it. Adding to its allure is the fact that it is difficult to get in the United States. I mentioned it to my doctor and he said that he could get it for me from one pharmacy located about 50 miles from my house. I had to have it shipped to me and it cost about $80 for a monthly supply. After the first month I noticed no benefit from taking this drug. I was reluctant to fill the prescription for the second month given the cost and the drug's dubious value, but consulted with my doctor who said that some people have gotten relief. So I tried it for another month, but again did not notice any benefit, so I quit taking it.

Diuretics and low salt diet

Diuretics are a standard treatment for Meniere's Disease, and I have taken them consistently since about a month after onset. These drugs cause you to urinate excess fluids and as such are supposedly helpful for the body to regain or maintain an equilibrium in the fluids of the inner ear. I am not certain why diuretics are appropriate for the inner ear whereas decongestants are appropriate for the middle ear, even though I asked my doctor. Diuretics are also given to reduce blood pressure.

One dangerous side effect of diuretics is that they may cause an electrolyte imbalance, particularly a lower-than-optimal potassium level. Consequently you must get periodic blood tests to monitor your electrolyte levels. The first diuretic I took was a strong one, and I ended up with bad side effects from low potassium after about a month. I remember feeling muscle cramping and joint stiffness that quickly worsened. I called my doctor who said to consume potassium rich foods such as bananas and orange juice and to stop taking the drug. I drank three glasses of orange juice and ate two bananas and went back to bed. After a couple of hours the side effects were gone.

My doctor then put me on a less potent, "potassium-sparing" diuretic called Acetazolamide. I take 250 mg twice a day. I am still careful about my potassium, trying to eat at least one banana and plenty of other fresh fruits and vegetables every day. If I start to feel tingling in my fingers and hands after a bike ride, I know that I need to eat more potassium. One lesson I learned is to turn to your pharmacist rather than your doctor for specific advice and information about your medications. When I mentioned to my doctor the side effects of tingling fingers and low potassium, he said that I should not experience these because Acetazolamide is a potassium-sparing drug, so it must be from something else. But my pharmacist said these side effects are common and that eating potassium-rich foods is advisable.

I cannot honestly say whether or not the diuretics help because I have taken them consistently since my symptoms started. I have asked my doctor about going off them and he strongly advises against it. He said that he has had patients who got better and decided to quit diuretics and subsequently saw a return of their symptoms, in some cases worse than before. I do believe that if one were able to maintain a low salt diet consistently, diuretics would not be necessary. My doctor advised that I cut my salt intake to under 1000 mg a day, which is less than half of our average daily amount. It stands to reason that the benefits of diuretics and a low salt diet would be comparable, as one helps to rid the body of excess fluid and the other prevents it from being retained in the first place.

I tried the low salt diet for about a month but found it very difficult to measure and to maintain and also did not feel improvement beyond just taking the diuretic. Maintaining a low salt diet essentially means staying away from restaurants and all prepared foods and snacks. It also means cooking your food separetely from your family's, or remembering to salt theirs at the end of the preparation, after you have already served yourself. Furthermore, I love salt. Unsalted food is just no fun.

That said, I have a feeling that I will try the low salt diet again, this time in earnest. At some point I would LOVE to be off all prescription medication and can foresee an immense satisfaction coming from managing the disease myself rather than relying on medication.

Valium

My doctor prescribed a low dose a valium early in the disease to help with the vertigo attacks. I did not feel that the valium helped much and therefore did not ask for another prescription.

Vitamins

I read one nutritionist's view that Meniere's syndrome could result from a deficiency in certain B-complex vitamins. I purchased vitamins based on these recommendations and have been taking them ever since. Although I cannot compare my present condition to a time when I had Meniere's Disease and did not take the vitamins, I do not believe that they are helping me. I have decided that I will not buy more once they run out.

Herbs

Most alternative medicine practitioners believe that gingkgo biloba improves blood flow and stimulates neuronal activity. I have seen it recommended specifically for Meniere's patients. I took it in capsule form for about two months and experienced no benefit, so I quit taking it.

Anti-Depressants

I currently take 150 mg of Effexor daily. I started this about one month after onset of Meniere's. Effexor is a selective serotonin reuptake inhibitor (SSRI), similar to Paxil and Zoloft. It is used to treat anxiety and mild depression, both of which I was feeling in abundance at the beginning of this illness. I saw a counselor who diagnosed anxiety and episodic depression brought on by the Meniere's. (A psychiatrist must prescribe anti-depressants.) Although my ENT has not specifically recommended anti-depressants, he has indicated that he thought that it was a good idea that I was taking them.

I believe that the Effexor helped me greatly in the first four months or so of this disease. I recall one episode several weeks after onset where my wife was to leave town for a two day business trip, leaving me to take care of the kids myself. I recall feeling a nearly crippling level of terror at the prospect of having to do this, despite the fact that at this point my attacks were infrequent and manageable, and I could always have called a friend or neighbor if necessary. Yet I was still nearly catatonic with fear and apprehension. At this point I knew something was wrong and that I would likely benefit from counseling and medication.

Now that my Meniere's has stabilized and I am living a normal and active life, I do not feel that I will need to continue taking the anti-depressant for much longer. I feel as though I will be able to function just as well with regular counseling in place of medication.

Summary

The only drugs that I currently take and that I believe have helped me are the diuretic and the anti-depressant. I believe that the diuretic is useful but could be replaced by a rigorous low salt diet. I believe that the anti-depressant was most effective for me during the first few months of the disease and is becoming less and less necessary as the disease stabilizes and I am able to identify my own effective coping mechanisms.