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The primary medication used for managing Meniere's disease is betahistine. Betahistine is believed to improve the microcirculation of the inner ear and increase the tolerance of pressure changes within the inner ear structures. It works as a histamine analogue and may help alleviate vertigo symptoms associated with Meniere's disease by enhancing blood flow and reducing endolymphatic pressure within the cochlea and vestibular system.

In contrast, while diuretics are sometimes used to manage fluid retention in patients with Meniere's disease, they are not the first-line treatment like betahistine. Alpha 1 antagonists are not appropriate for this condition as they target different receptor sites and systems in the body. Antihistamines can help manage some of the symptoms related to vertigo and nausea but are not considered the primary treatment strategy for Meniere's disease itself, as they do not address the underlying pathophysiology.