W. Steven Pray, PhD, DPh


US Pharmacist. 2005;30(7) 

In This Article


Meniere's syndrome is an umbrella term for such conditions as tinnitus, hearing loss, aural fullness, and recurrent, spontaneous episodes of vertigo. It may be caused by several etiologies: (1) Meniere's disease, also known as the idiopathic form; (2) trauma, perhaps after ear surgery or injury to the head; (3) viral infection, measles, or mumps, also known as the delayed-onset Meniere's syndrome; (4) syphilis in the latter stages; and (5) Cogan's syndrome. The most common cause of the syndrome is Meniere's disease. The patient is reported to have the disease only when medical examination has excluded the other four possible etiologies.[8]

The underlying cause of idiopathic Meniere's disease is a condition known as endolymphatic hydrops. Hydrops is defined in Stedman's Concise Medical Dictionary as "an excessive accumulation of clear, watery fluid in any of the tissues or cavities of the body." The same source defines endolymph as the "fluid contained within the membranous labyrinth of the inner ear." Thus, in Meniere's disease, excessive fluid has accumulated in the inner ear, which also comprises the semicircular canals crucial to balance and the cochlea, integral to hearing.[5]

Can Bonine Be Recommended for Meniere's Disease?
Pharmacists have often been puzzled about the difference in nonprescription Bonine (or generic meclizine) and prescription Antivert. The strengths are identical, yet one cannot be bought without a prescription. The difference hinges on the indications and labeling. Nonprescription meclizine is labeled only for motion sickness, a minor condition of known etiology considered by the FDA as self-treatable. On the other hand, Antivert is indicated for vertigo. Vertigo has many causes, some serious (e.g., ingestion of ototoxic medications). Thus, vertigo requires a physician's skill in differential diagnosis before meclizine can be considered useful. A patient using meclizine for vertigo without physician consultation could experience apparent relief but mask a serious underlying medical condition that would remain unchecked. For this reason, patients requesting meclizine or Bonine for vertigo should always be urged to consult a physician, if they have not already done so.


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