From the Guidelines
Betahistine is contraindicated in patients with pheochromocytoma, and its use should be avoided or approached with caution in patients with asthma, history of peptic ulcer disease, and other specific conditions. The use of betahistine, a histamine H1 receptor agonist, is generally considered safe, but there are certain conditions where its use may be harmful or require careful consideration [ 1 ].
Contraindications and Precautions
- Pheochromocytoma: Betahistine should be avoided in patients with pheochromocytoma due to the risk of inducing the release of catecholamines from the tumor, potentially causing a hypertensive crisis [ 1 ].
- Asthma: Patients with a history of bronchial asthma should use betahistine with caution because of its histaminergic properties that may trigger bronchospasm [ 1 ].
- Peptic Ulcer Disease: Betahistine should be used with caution in patients with a history of peptic ulcer disease, as it may increase gastric acid secretion and worsen ulcers [ 1 ].
- Other Considerations: While not explicitly contraindicated, patients with certain conditions or taking specific medications should be monitored closely when using betahistine, given its potential side effects, such as headache, balance disorder, nausea, and others [ 1 ].
Clinical Use and Monitoring
The decision to use betahistine should be based on a thorough assessment of the patient's condition, including the presence of any contraindications or precautions. Patients initiated on betahistine should be reassessed regularly for improvement or stabilization of symptoms, as well as for potential side effects or intolerance to the medication [ 1 ]. The length of treatment with betahistine may vary, but most studies have covered periods ranging from 2 to 12 weeks, with one recent study extending to 9 months [ 1 ].
From the FDA Drug Label
CONTRAINDICATIONS Histamine should not be injected into individuals with hypotension, severe hypertension, severe cardiac, pulmonary, or renal disease. Not to be used for diagnosis of pheochromocytoma or to test the ability of the gastric mucosa to secrete hydrochloric acid. The contraindications to the use of betahistine are:
- Hypotension
- Severe hypertension
- Severe cardiac disease
- Severe pulmonary disease
- Severe renal disease
- Diagnosis of pheochromocytoma
- Testing the ability of the gastric mucosa to secrete hydrochloric acid 2
From the Research
Contraindications to the Use of Betahistine
The use of betahistine, a histamine (H1) receptor agonist, has been studied in various contexts, including the treatment of vestibular disorders such as Ménière's disease and vertigo. While betahistine is generally considered safe, there are some contraindications and precautions to be aware of:
- Cutaneous hypersensitivity reactions, including rash, pruritus, and urticaria, have been reported in some patients taking betahistine 3.
- Gastrointestinal complaints, such as nausea and vomiting, have also been reported, although these are typically non-serious 3.
- Hepatobiliary involvement, including increases in liver enzymes, has been reported in some cases, but none of these cases resulted in severe liver failure or death 3.
- Anaphylactoid reactions, including one case of Stevens-Johnson syndrome, have been reported, although anaphylactic reactions with fatal outcomes were not reported 3.
- Asthma or bronchospasm have been reported in a few cases, suggesting that betahistine may not be suitable for patients with pre-existing respiratory conditions 3.
- There is limited information on the use of betahistine in patients with certain medical conditions, such as phaeochromocytoma, and caution should be exercised when prescribing betahistine to these patients 3.
Special Precautions
When using betahistine, special precautions should be taken in certain patient populations:
- Patients with a history of hypersensitivity reactions should be monitored closely for signs of an allergic reaction 3.
- Patients with gastrointestinal disorders, such as ulcers or bleeding, should be cautious when taking betahistine, as it may exacerbate these conditions 3.
- Patients with liver disease should be monitored for changes in liver function, as betahistine may affect liver enzymes 3.
- Patients with respiratory conditions, such as asthma, should be cautious when taking betahistine, as it may trigger bronchospasm 3.
Drug Interactions
Betahistine may interact with other medications, including: