What pharmacological treatments are recommended for managing acute episodes of vertigo in Ménière's disease?

For managing acute episodes of vertigo in patients with Ménière's disease, pharmacological treatment primarily focuses on symptomatic relief. Vestibular suppressants such as prochlorperazine or promethazine are commonly recommended to control nausea and vertigo during acute attacks NICE NG127. Additionally, short courses of benzodiazepines like diazepam may be used to reduce vestibular excitability and alleviate vertigo symptoms NICE NG127. Antihistamines with anticholinergic properties, such as betahistine, are often prescribed to improve inner ear microcirculation and reduce the frequency and severity of vertigo episodes, although their efficacy in acute attacks is more supportive than curative NICE NG127. Diuretics may be used adjunctively to manage endolymphatic hydrops, but they are not first-line for acute vertigo relief NICE NG127.

While UK guidelines emphasize symptomatic pharmacological management during acute episodes, recent literature highlights that intratympanic therapies, such as gentamicin injections, are reserved for medically refractory cases rather than acute symptom control Cohen-Kerem et al. 2004. Surgical interventions remain a consideration only after pharmacological and conservative measures fail Lucas & Hong 2023Yu & Chen 2025. Thus, the pharmacological approach in acute vertigo episodes remains centered on vestibular suppressants and antiemetics as first-line treatments, consistent with UK clinical guidance NICE NG127.