Integrative & Personalized Medicine

Ménière's Disease & Vertigo Support

Also called Meniere's disease, Meniere's syndrome, endolymphatic hydrops, inner ear vertigo

Ménière's disease causes vertigo attacks, fluctuating hearing loss, and ringing in one ear. When a provider prescribes a medicine in a form you cannot find, Mixwell in Chino, CA prepares it.

Reviewed by Linda Pungpravat, Compounding Pharmacist, RPh Mixwell Compounding Pharmacy, Chino, CA

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Ménière's Disease & Vertigo Support

Signs people notice

  • Spinning vertigo attacks lasting 20 minutes to several hours
  • Hearing loss in one ear that comes and goes
  • Ringing, roaring, or buzzing in the ear
  • Fullness or pressure in the ear
  • Nausea or vomiting during an attack
  • Feeling unsteady for a while after an attack

Clinical Overview

What is Ménière's disease?

Ménière's disease is an inner ear disorder that causes repeated attacks of spinning vertigo lasting 20 minutes to 12 hours, along with fluctuating hearing loss, ringing, or fullness in the affected ear. It affects about 50 to 200 of every 100,000 adults and is most common between ages 40 and 60 [1].

How it is diagnosed

Diagnosis rests on the pattern of attacks and a hearing test showing fluctuating low to mid frequency hearing loss in the affected ear [1]. Guidelines also call for checking whether vestibular migraine better explains the symptoms, and an MRI may be offered when hearing loss is uneven between the ears [1].

How it is managed

The AAO-HNS guideline recommends education on diet and lifestyle changes. Clinicians may offer diuretics and/or betahistine to reduce symptoms or prevent attacks, an option based on studies with a high risk of bias [1]. It recommends against positive pressure devices and lists injected treatments in the middle ear for attacks that continue [1].

In the BEMED trial, 221 adults with Ménière's disease received placebo or one of two betahistine doses for nine months. Attack rates did not differ between the groups, and they fell in all three, including placebo [2].

How Compounding Can Help

Most Ménière's treatments, such as diuretics, are available commercially. A compounding pharmacy can help when a patient cannot take the commercial form.

  • Oral liquids of prescribed medicines for patients who cannot swallow tablets
  • Custom strengths when a dose falls between commercial tablet sizes
  • Dye free and filler conscious versions for patients who react to an ingredient

Betahistine has no FDA approved product in the United States, and federal rules strictly limit which bulk ingredients a compounding pharmacy may use. The largest trial of betahistine also found no benefit over placebo [2]. Your provider and pharmacist can explain which options are available for you.

What to ask your provider

  • Do my symptoms fit Ménière's disease, or could this be vestibular migraine or another cause?
  • Should I have a hearing test, and do I need an MRI?
  • Which diet or lifestyle changes are worth trying first?
  • What does the evidence show for the medicines you are recommending?
  • What are the next steps if attacks continue?
  • What should I do during an attack?
Call (909) 378-7301

Common Questions

What is Ménière's disease?

Ménière's disease is an inner ear disorder that causes repeated attacks of spinning vertigo, along with hearing loss that comes and goes, ringing, and fullness in one ear. Attacks last from 20 minutes to several hours. It is most common between ages 40 and 60, and a hearing test is part of diagnosis.

Does betahistine work for Ménière's disease?

The evidence is mixed. The US guideline lists betahistine as an option clinicians may offer, based on studies with a high risk of bias. The largest trial, published in 2016, found no difference in attack rates between betahistine and placebo over nine months. Your provider can explain whether it fits your situation.

Is betahistine available in the United States?

Betahistine is prescribed in Europe and other countries, but it has no FDA approved product in the United States. Federal rules strictly limit which bulk ingredients compounding pharmacies may use, so ask your prescriber and pharmacist about current options for your situation.

Are compounded medications FDA approved?

No. Compounded preparations are not reviewed or approved by the FDA for safety or effectiveness, and they are dispensed only with a valid prescription for one patient. The FDA recommends an FDA approved drug when one is available and appropriate for the patient. Your prescriber decides when a compounded preparation fits.

References
  1. Basura GJ, Adams ME, Monfared A, et al. Clinical practice guideline: Ménière's disease. Otolaryngol Head Neck Surg. 2020;162(2 Suppl):S1 to S55. doi:10.1177/0194599820909438
  2. Adrion C, Fischer CS, Wagner J, Gürkov R, Mansmann U, Strupp M; BEMED Study Group. Efficacy and safety of betahistine treatment in patients with Meniere's disease: primary results of a long term, multicentre, double blind, randomised, placebo controlled, dose defining trial (BEMED trial). BMJ. 2016;352:h6816. doi:10.1136/bmj.h6816
  3. Chandrasekhar SS, Tsai Do BS, Schwartz SR, et al. Clinical practice guideline: sudden hearing loss (update). Otolaryngol Head Neck Surg. 2019;161(1 Suppl):S1 to S45. doi:10.1177/0194599819859885
  4. Centers for Disease Control and Prevention. Signs and symptoms of stroke. CDC

Compounded in Chino, CA. Delivered across California.

  • Chino
  • Chino Hills
  • Ontario
  • Pomona
  • Diamond Bar
  • Rancho Cucamonga
  • Eastvale
Mixwell Compounding Pharmacy 13788 Roswell Ave, Ste 158, Chino, CA 91710
(909) 378-7301

Mixwell is a state licensed, non sterile compounding pharmacy and a PCCA member, preparing each formula in a lab built to USP 795 and USP 800 standards. Compounded medications are not reviewed or approved by the FDA and are dispensed only with a valid prescription. We do not prepare sterile products or injectables. Nothing here promises a specific result, and compounded preparations are not presented as superior to commercially available products. Mixwell does not accept insurance. Call for pricing.

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