What is the treatment for Meniere's disease using Betahistine?

Treatment of Meniere's Disease with Betahistine

Betahistine is recommended at a standard initial dose of 48 mg daily in divided doses as first-line therapy for Meniere's disease to reduce vertigo attacks, although recent high-quality evidence suggests its efficacy may not be superior to placebo. 1

Dosage and Administration

• Initial dosing: 48 mg daily, divided into three doses of 16 mg each 1
• Dose range: 24-144 mg daily, depending on clinical response 1
• Administration: Take with food to minimize gastrointestinal side effects 1
• Treatment duration: Evaluate efficacy after 2-3 months of therapy 1

Efficacy for Specific Symptoms

Vertigo Control

• Most effective for reducing vertigo during the intercritical phase (between acute attacks) with 87% expert agreement 2
• Less effective during acute attacks; should be combined with other medications during these episodes 2
• Can be combined with intratympanic steroid therapy for enhanced vertigo control (73% control with combination vs. 44% with steroids alone) 3

Other Symptoms

• Limited efficacy for hearing loss, tinnitus, and aural fullness 2
• Some evidence suggests potential benefit for preventing/reversing hearing deterioration, particularly in patients who are younger, have shorter disease duration, and less severe initial hearing loss 4

Monitoring Treatment Response

• Regularly track changes in:
  • Frequency and severity of vertigo attacks
  • Hearing function
  • Tinnitus intensity
  • Sensation of aural fullness 1

Management of Inadequate Response

If inadequate response after 2-3 months:

1. Consider dose adjustment (up to 144 mg daily) 1
2. Add vestibular rehabilitation/physical therapy 1
3. For persistent vertigo despite medical therapy, consider intratympanic gentamicin injections, which provide complete vertigo control in approximately 73.6% of patients 3

Contraindications and Precautions

• Use with caution in patients with:
  • Asthma
  • History of peptic ulcer disease 1
• Avoid in patients with pheochromocytoma 1

Side Effects

Common side effects are generally mild and include:

• Headache
• Balance disorders
• Nausea
• Gastrointestinal symptoms
• Palpitations 1

Important Considerations

• The BEMED randomized controlled trial found no significant differences between betahistine (at both 48 mg/day and 144 mg/day) and placebo in reducing vertigo attacks after 9 months 1
• A 2022 systematic review found limited high-quality evidence supporting betahistine's efficacy over placebo for vertigo in Meniere's disease 5
• Patient factors that may predict better response to betahistine include:
  • Age under 47 years
  • Disease duration less than 1.4 years
  • Initial hearing level better than 38dB HL 4

Despite some conflicting evidence regarding efficacy, betahistine remains a first-line treatment for Meniere's disease due to its favorable safety profile and potential benefits for vertigo control, particularly when used as maintenance therapy between acute attacks.