cinnarizine and Meniere-Disease

Prophylactic therapy of Ménière's disease (MD) includes betahistine and calcium-blockers (the latter also useful for migraine prevention). The aim of our work was to assess the efficacy of combined therapy with cinnarizine and betahistine in MD subjects both with and without migraine and poorly responsive to betahistine alone. Fifty-two MD subjects were included who were poorly responsive to betahistine during 6 months of follow-up; 29 were migraineurs. Combined therapy was administered with betahistine 48 mg/day and cinnarizine 20 mg BID for 1 month, 20 mg/day for 2 weeks and 20 mg every 2 days for 2 more weeks, and then repeated. Results were collected over 6 months of follow-up. MD subjects with and without migraine demonstrated a decrease in both vertigo spells and migrainous attacks during combined therapy (from 9.4 to 3.8 and from 6.8 to 5.9 in 6 months, respectively, for vertigo spells, while migraine decreased from 3.8 to 1 in 6 months, respectively). A correlation was seen between decrease of vertigo spells and headaches in the sample of MD subjects with migraine. Our data support a proactive role for cinnarizine in preventing vertigo spells, especially in MD patients with migraine.. La betaistina e i calcio-antagonisti si sono dimostrati efficaci nella profilassi della Sindrome di Ménière; i calcio-antagonisti sono utilizzati anche nella prevenzione degli episodi di cefalea emicranica. Scopo del nostro lavoro è stato quello di stabilire l'efficacia della terapia combinata con cinnarizina e betaistina nella prevenzione delle crisi vertiginose in un gruppo di pazienti affetti da Sindrome di Ménière senza e con comorbidità per emicrania. Cinquantadue pazienti affetti da Sindrome di Ménière, poco responsivi alla sola terapia con betaistina in un periodo di 6 mesi, sono stati inclusi nello studio, 29 dei quali emicranici. Nei 6 mesi successivi è stata effettuata terapia combinata con betaistina (48 mg al giorno) e cinnarizina 20 mg due volte al giorno per 1 mese, 20 mg al giorno per 2 settimane e 20 mg a giorni alterni per 2 ulteriori settimane; lo schema terapeutico è stato indi ripetuto. I dati relativi alla frequenza delle crisi vertiginose sono stati collezionati nei 6 mesi successivi. In entrambi i gruppi è stato dimostrato un decremento delle crisi vertiginose (da 9.4 a 3.8 in 6 mesi e da 6.8 a 5.9 in 6 mesi rispettivamente nel gruppo con e senza comorbidità per emicrania; le crisi di cefalea si sono inoltre ridotte da 3.8 a 1 in 6 mesi). È stata evidenziata una correlazione tra la diminuzione degli attacchi di vertigine ed emicrania. I nostri dati sottolineano un ruolo terapeutico della cinnarizina nella prevenzione degli attacchi di vertigine soprattutto nei soggetti con comorbidità emicranica.

Topics: Betahistine; Calcium Channel Blockers; Cinnarizine; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Male; Meniere Disease; Middle Aged; Migraine Disorders; Vertigo

The management of Ménière's disease continues to provide a formidable clinical challenge, mainly because its precise aetiology is unknown. The unpredictable natural history of the condition has consistently bedevilled attempts to evaluate therapeutic efficacy, and there have been no entirely satisfactory prospective controlled clinical trials of any specific medical or surgical treatment. Although no form of medication has been convincingly shown to influence the long term course of the disease, many drugs may be useful in the control of vertigo. In recent years conservation of hearing has assumed equal importance to the control of vertigo as the therapeutic goal. Indications for conservative endolymphatic sac surgery, which appears to offer the best prospect of preventing the progressive deafness which invariably accompanies the established condition, are discussed. The necessity for a flexible therapeutic approach to the management of Ménière's disease is underlined.

Topics: Audiometry, Evoked Response; Cinnarizine; Diuretics; Humans; Meniere Disease; Prochlorperazine; Vasodilator Agents

In this decision-tree analysis, the costs of otogenic vertigo treatment were investigated from the third-party payer's perspective. Either the combination preparation, with cinnarizine 20 mg and dimenhydrinate 40 mg as active substances, or betahistine (12 mg betahistinedimesilate) was administered.. A core model, based on clinical studies, was developed and a cost-effectiveness analysis was conducted. Both differences in effectiveness of the alternative treatments and adverse reactions and side effects were included. The number of cases, in which no more symptoms of dizziness were detected after 4 weeks of therapy, served as the effectiveness parameter.. The effectiveness-adjusted costs amounted to 130.11 Euros for patients treated with the combination preparation and 629.28 Euros for treatment with betahistine.. From the third-party payer's perspective, therapy of otogenic vertigo with the combination preparation is more cost-effective than a treatment with betahistine. From the patient's perspective, the higher effectiveness and the superior profile of side effects militate in favor of a therapy with the combination preparation.

Topics: Adult; Betahistine; Cinnarizine; Cost-Benefit Analysis; Decision Trees; Dimenhydrinate; Drug Combinations; Drug Costs; Evidence-Based Medicine; Female; Histamine Agonists; Humans; Male; Meniere Disease; National Health Programs

In a randomized, double-blind clinical study, we evaluated the efficacy and tolerability of the fixed combination of cinnarizine, 20 mg, and dimenhydrinate, 40 mg (Arlevert [ARL]) in comparison to betahistine dimesylate (12 mg) in 82 patients suffering from Ménière's disease for at least 3 months and showing the characteristic triad of symptoms (paroxysmal vertigo attacks, cochlear hearing loss, and tinnitus). The treatment (one tablet three times daily) extended to 12 weeks, with control visits at 1, 3, 6, and 12 weeks after drug intake. The study demonstrated for both the fixed-combination ARL and for betahistine a highly efficient reduction of vertigo symptoms in the course of the 12 weeks of treatment; however, no statistically significant difference between the two treatment groups could be established. Similar results were found for tinnitus (approximately 60% reduction) and for the associated vegetative symptoms (almost complete disappearance). Vestibulospinal reactions, recorded by means of craniocorpography, also improved distinctly, with a statistically significant superiority of ARL versus betahistine (p < .042) for the parameter of lateral sway (Unterberger's test). The caloric tests (electronystagmography) showed only minor changes for both treatment groups in the course of the study. A statistically significant improvement of hearing function of the affected ear (p = .042) was found for the combination preparation after 12 weeks of treatment. The tolerability was judged by the vast majority of patients (97.5%) in both groups to be very good. Only one patient (betahistine group) reported a nonserious adverse event, and two betahistine patients did not complete the study. In conclusion, the combination preparation proved to be a highly efficient and safe treatment option for Ménière's disease and may be used both in the management of acute episodes and in long-term treatment. Efficacy and safety were found to be similar to the widely used standard therapy with betahistine.

Topics: Adult; Aged; Betahistine; Cinnarizine; Dimenhydrinate; Double-Blind Method; Drug Combinations; Female; Histamine Agonists; Histamine H1 Antagonists; Humans; Male; Meniere Disease; Middle Aged; Treatment Outcome; Vertigo

Topics: Adult; Aged; Cinnarizine; Clinical Trials as Topic; Double-Blind Method; Electroencephalography; Electronystagmography; Evoked Potentials; Female; Flunarizine; Humans; Male; Meniere Disease; Middle Aged; Sulpiride; Vasodilator Agents; Vertebrobasilar Insufficiency; Vestibular Function Tests; Vestibule, Labyrinth

Topics: Aged; Cinnarizine; Dimenhydrinate; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Combinations; Humans; Meniere Disease

Topics: Cinnarizine; Clinical Trials as Topic; Dimenhydrinate; Dizziness; Drug Combinations; Evidence-Based Medicine; Germany; Humans; Meniere Disease; Vertigo

Meniere's disease is a condition with sudden attacks of vertigo with nausea and vomiting accompanied by loss of hearing and buzzing sensation in the ears, most commonly unilateral. The exact cause of the disease is unknown. Betahistine is the analogue of histamine with weaker agonistic effect on histamine H1 receptors and stronger effect on histamine H3 receptors, while Cinnarizine has more effective effect on H1 receptors.. The aim is to determine which drug is more effective in the treatment of Meniere's disease Betahistine or Cinnarizine.. This study evaluates the effectiveness of Betahistine in 37 patients with the Meniere's syndrome accompanied by classic triad of symptoms treated in hospital conditions and Cinnarizine effect in 36 patients with a less severe clinical picture, which were treated as outpatients. To all patients were conducted laboratory tests, brain CAT (to exclude possible expansive process, MS or stroke) and TCD in order to eliminate any possible circulatory disturbances in VB basin. Group with classic Meniere's syndrome was treated at a dose of Betahistine of 3 x 16 mg and followed 8 weeks, while the second group was treated with Cinnarizine at a dose of 2 x 75 mg and also followed for 8 weeks.. Already after one month of therapy was noticed better effect in case of Betahistine in terms of symptoms reduction compared to the Cinnarizine effect.

Topics: Adult; Betahistine; Cinnarizine; Female; Histamine Agonists; Histamine H1 Antagonists; Humans; Male; Meniere Disease; Middle Aged

Vestibular vertigo may be induced by increases in the endolymphatic pressure that activate pressure-dependent K(+) currents (I(K,p)) in vestibular hair cells. I(K,p) have been demonstrated to modulate transmitter release and are inhibited by low concentrations of cinnarizine. Beneficial effects against vestibular vertigo of cinnarizine have been attributed to its inhibition of calcium currents. Our aim was to determine the extent by which the inhibition of I(K,p) by cinnarizine may alter the voltage response to stimulating currents and to analyze whether such alterations may be sufficient to modulate the activation of Ca(2+) currents and transmitter release. Vestibular type II hair cells from guinea pigs were studied using the whole-cell patch-clamp technique. In current clamp, voltage responses to trains of stimulating currents were recorded. In voltage clamp, transmitter release was assessed from changes in the cell capacitance, as calculated from the phase shift during application of sine waves. Cinnarizine (0.05-3 microM) concentration dependently reversed the depressing effects of increases in the hydrostatic pressure (from 0.2 to 0.5 cm H(2)O) on the voltage responses to stimulating currents. Voltage protocols that simulated these responses were applied in voltage clamp and revealed a significantly enhanced transmitter release in conditions mimicking an inhibition of I(K,p). Cinnarizine (< or =0.5 microM) did not inhibit calcium currents. We conclude that cinnarizine, in pharmacologically relevant concentrations, enhances transmitter release in the presence of elevated hydrostatic pressure by an indirect mechanism, involving inhibition of I(K,p), enhancing depolarization, and increasing the voltage-dependent activation of Ca(2+) currents, without directly affecting Ca(2+) current.

Topics: Animals; Calcium; Calcium Channel Blockers; Cinnarizine; Dose-Response Relationship, Drug; Female; Guinea Pigs; Hair Cells, Vestibular; Hydrostatic Pressure; Meniere Disease; Patch-Clamp Techniques; Potassium Channels

The efficacy of medical treatment in preventing the need for vestibular neurectomy (VN) in patients with disabling Ménière's disease, and in facilitating postoperative compensation of equilibrium after VN, was investigated. Ninety-five patients with classic symptoms of unilateral incapacitating Ménière's disease were included. Patients were treated with either 16 mg betahistine three-times daily (n = 49) or 125 mg acetazolamide once-daily (n = 46) for 6 months. The study showed that marked benefit was achieved in 51 of the 95 patients, of whom significantly more were in the betahistine group than in the acetazolamide group [32 (65%) vs 19 (41%); p < 0.05]. Twenty-seven patients in the acetazolamide group and 17 in the betahistine group experienced no benefit from medical treatment and therefore underwent VN. Twelve patients in the betahistine group and 6 in the acetazolamide group eventually experienced a relapse and thus also underwent VN. Therefore 62 patients in total underwent VN. Following surgery, patients were given medical treatment in an attempt to facilitate vestibular compensation; 28 received betahistine (16 mg three-times daily) and 34 received cinnarizine (25 mg three-times daily) for 3 months. The patients treated with betahistine had a shorter period of disability and significantly better results on rotatory testing. In conclusion we recommend the use of betahistine in patients who have undergone VN.

Topics: Acetazolamide; Adult; Betahistine; Cinnarizine; Diuretics; Female; Histamine Agonists; Histamine H1 Antagonists; Humans; Male; Meniere Disease; Middle Aged; Vestibular Nerve

Topics: Betahistine; Cinnarizine; Humans; Meniere Disease; Piperazines; Pyridines; Vertigo

Topics: Blood Viscosity; Cinnarizine; Double-Blind Method; Flunarizine; Humans; Ischemia; Meniere Disease; Physical Exertion; Piperazines; Vasodilator Agents

Topics: Adult; Aged; Cinnarizine; Diffuse Cerebral Sclerosis of Schilder; Female; Flunarizine; Hearing Loss, Central; Humans; Male; Meniere Disease; Middle Aged; Piperazines

There is no causal medical treatment of Menière's disease, further it seems very doubtful if it is possible to achieve a complete loss of symptoms by drugs alone. In spite of the fact that there are a great number of drugs being applied, there are some general principles in the treatment of this disease which should be followed. These principles are: 1. Improvement of blood supply of the inner ear by various methods. 2. Sedation of the patients to avoid physical stress, as it has clearly been shown that in many patients there is a correlation between psychical stress and Menière attacks. 3. Dehydration of the inner ear hydrops by osmotic diuresis or diuretic drugs. 4. Partial destruction of inner ear structures by intratympanally administration of ototoxic drugs or anaesthetics.

Topics: Cinnarizine; Dextrans; Diazepam; Humans; Hypnotics and Sedatives; Meniere Disease

Topics: Adult; Cinnarizine; Diagnostic Errors; Female; Humans; Hyperbilirubinemia, Hereditary; Meniere Disease

Topics: Adult; Cinnarizine; Deceleration; Electronystagmography; Eye Movements; Female; Humans; Male; Meniere Disease; Piperazines; Rotation