Picrotoxin in the long-term treatment of Menière’s disease – a retrospective case series

Introduction According to the German Menière’s disease guidelines, oral medication with betahistine, intratympanic treatment with dexamethasone or gentamicin, and surgical procedures such as endolymphatic sac decompression or vestibular neurectomy represent the available treatment options. In our department, we treat patients who have received picrotoxin as off-label use for almost 20 years in some cases. This case series is presented here retrospectively.

Methods Picrotoxin is a GABA-A antagonist whose active ingredient is extracted from the Indian Berry plant and administered as a suppository. The standard dosage is three suppositories per week. The retrospective analysis included patients from the neurootology outpatient clinic of the Charité who were treated with picrotoxin after exhaustion of other conservative therapeutic measures and showed an improvement of their symptoms.

Results Twelve patients are presented with definite Menière’s disease, according to the Bárány society criteria, who are receiving picrotoxin therapy (nine female, three male, mean age 66.9 years). Ten patients (83.3%) reported no more vertigo attacks and were very satisfied with the treatment. The maximum reported duration of picrotoxin therapy was 18 years. No relevant side effects were reported.

Discussion Based on the findings, the value of picrotoxin therapy for Menière’s disease should be re-evaluated and offered to selected patients after exhausting other therapeutic measures.

Publication History

Article published online:
12 May 2023