Re: Meniere's disease

[Guest guest]

Dear Benn,

In the treatment of Meniere's syndrome, vestibular sedatives like

Cinnarazine seem to be prescribed along side the histamine

analogue - Betahistine (Serc). They have different modes of action which,

do not appear to affect each other.

According to the data sheet compendium; " Betahistine is an orally effective

treatment for Meniers syndrome, which appears to exert its effect by

reducing endolymphatic pressure. It was developed following the successful

parenteral use of histamine in patients with Meniere's ........ Although an

antagonism between Serc and antihistamines could be expected on a

theoretical basis, no such interactions have been reported " .

I remember a patient at the training clinic who was also prescribed a

combination of Serc and Lustral but she was clearly very anxious and

depressed as well as having Meniere's syndrome. Although she found the

herbal treatment supportive, the treatment she found the most helpful was a

series of exercises which she was given by her hospital consultant. I can't

remember the name of the exercises - Allshorn may remember this

patient. They were very gentle exercises to help with co-ordination and

balance. However, these may not be suitable for an elderly patient with OA.

As for the relationship between Lustral and exacerbation of OA symptoms,

although arthralgia and myalgia are mentioned under ADR in MIMMS and the

BNF, it is not a side effect referred to in the Datasheet Compendium.

Perhaps

you could contact the GP (with the patients permission) and ask them if, in

their clinical experience, they think this patient's exacerbation is likely

to be caused by this drug.

Best regards,

Charlotte Stedman BSc (herb.med.), MNIMH

charlotte2.stedman@...

----- Original Message -----

Benn wrote:

A new Px today, 87yo with Meniere's disease/syndrome - possibly

secondary to a mugging assault in December 95.

Primary drug Tx included Betahistine dihydrochloride, a histamine

analogue...

Later when Px unable to cope, Cinnarizine was prescribed, this is an

anti-histamine...

Somewhere along the way, Sertraline hydrochloride (Lustral) was

prescribed... which is associated with arthralgia and myalgia... and the

Px's osteoarthritic condition is worsening... I am not even sure why the

Lustral was prescribed...

My queries are

1) is the Cinnarizine merely counteracting the Betahistine - so is there

over-medicating?

2) how do I gently communicate my concern to the Px's GP re: the drug

relationship and the possible exacerbation of OA symptoms by the

Lustral?