Medication Summary
Oral corticosteroids and oral acyclovir are frequently prescribed in patients with Ramsay Hunt syndrome. Vestibular suppressants may be helpful if vestibular symptoms are severe. Carbamazepine may be helpful, especially in cases of idiopathic geniculate neuralgia.
Corticosteroids
Class Summary
These agents reduce the inflammation of the cranial nerves and help alleviate the pain and neurologic symptoms.
Prednisone (Rayos, Deltasone)
May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. May be taken during acute inflammatory period (1-2 wk) and then tapered slowly. As an alternative, Dosepaks (ie, several prepackaged tablets with decreasing doses) can be taken. Individualize dose based on response.
Antivirals
Class Summary
Acyclovir can be used to combat infection caused by herpesviruses such as VZV.
Acyclovir (Zovirax)
Patients experience less pain and faster resolution of symptoms when used within 48 h from onset of symptoms. May prevent recurrent outbreaks.
Anticonvulsants
Class Summary
Mechanism of action of antiepileptics in this syndrome is still unknown. Carbamazepine has been shown to help the neuralgic pain associated with this syndrome, especially in cases of idiopathic geniculate neuralgia.
Carbamazepine (Tegretol, Carbatrol, Epitol, Equetro)
DOC that may reduce polysynaptic responses and block posttetanic potentiation. Adjust dose depending on response to treatment and blood levels.
Antihistamines
Class Summary
These agents prevent histamine responses in sensory nerve endings and blood vessels. They are effective in treating vertigo.
Meclizine (Medi-Meclizine, Dramamine Less Drowsy, Motion-Time, Travel Sickness)
Decreases excitability of middle ear labyrinth and blocks conduction in middle ear vestibular-cerebellar pathways. Associated with therapeutic effects in relief of nausea and vomiting.
Dimenhydrinate (Driminate, Dramamine, Motion Sickness)
A 1:1 salt of 8-chlorotheophylline and diphenhydramine thought to be useful in treatment of vertigo. Through central anticholinergic activity, diminishes vestibular stimulation and depresses labyrinthine function.
Anticholinergics
Class Summary
These agents are thought to work centrally by suppressing conduction in the vestibular-cerebellar pathways.
Scopolamine (Transderm-Scop)
Blocks action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and the CNS. Antagonizes histamine and serotonin action.
Transdermal scopolamine may be most effective agent for motion sickness. Its use in vestibular neuronitis limited by its slow onset of action.
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Herpes zoster oticus, day 6. Image courtesy of Manolette Roque, MD, ROQUE Eye Clinic.
