Should betahistine be discontinued gradually or abruptly?

From the Guidelines

Betahistine can be discontinued abruptly without the need for gradual tapering. This recommendation is based on the fact that betahistine, commonly prescribed for vestibular disorders like Ménière's disease, does not cause withdrawal effects when stopped suddenly 1. The medication works primarily as a histamine H1 receptor agonist and H3 receptor antagonist, affecting inner ear blood flow and vestibular function, but does not create physical dependence or adaptive changes in neurotransmitter systems that would necessitate gradual discontinuation.

Key Considerations

• The BEMED trial, a well-designed study, found no significant differences in mean attack rate per 30 days between the placebo and betahistine groups evaluated at 7 to 9 months of the treatment period 1.
• Serious medical side effects with betahistine are rare, and the medication should be used with caution in patients with asthma and history of peptic ulcer disease, and avoided in patients with pheochromocytoma 1.
• Patients should consult with their healthcare provider before stopping any medication, as their underlying condition may return once betahistine is discontinued.
• If symptoms recur after stopping betahistine, patients should report this to their healthcare provider, who may recommend resuming the medication or trying alternative treatments.

Clinical Implications

• The decision to discontinue betahistine should be made on a case-by-case basis, taking into account the individual patient's response to treatment and potential risks.
• Clinicians should monitor patients for any changes in symptoms or side effects after discontinuing betahistine, and adjust treatment plans as needed.
• Alternative treatments may be considered if symptoms recur after stopping betahistine, and patients should be educated on the potential benefits and risks of these alternatives.

From the Research

Discontinuation of Betahistine

• The provided studies do not directly address whether betahistine should be discontinued gradually or abruptly 2, 3, 4, 5, 6.
• However, a study on the rebound effect, discontinuation, and withdrawal syndromes associated with drugs used in psychiatric and neurological disorders suggests that sudden cessation of a drug can cause withdrawal syndrome, discontinuation syndrome, or rebound effect 6.
• Another study on the clinical management of antidepressant discontinuation recommends gradual tapering to minimize discontinuation symptoms, which may be relevant to other medications like betahistine 2.
• There is no specific guidance on the discontinuation of betahistine in the provided studies, but it may be prudent to consider a gradual tapering approach to minimize potential discontinuation symptoms, based on the principles of discontinuing other medications 2, 6.

Potential Consequences of Abrupt Discontinuation

• Abrupt discontinuation of betahistine may lead to rebound effects or discontinuation symptoms, although the specific risks associated with betahistine are not well-documented in the provided studies 6.
• The study on rebound effect, discontinuation, and withdrawal syndromes suggests that these phenomena are characterized by varying clusters of somatic, autonomic, and psychiatric symptoms, which may be relevant to betahistine discontinuation 6.
• However, without specific studies on betahistine discontinuation, it is difficult to determine the exact risks and consequences of abrupt versus gradual discontinuation 2, 3, 4, 5, 6.