Does betahistine cause tinnitus (ringing in the ears)?

From the Guidelines

Betahistine does not typically cause tinnitus; in fact, it is often prescribed to treat tinnitus and vertigo associated with Ménière's disease. According to the most recent and highest quality study, the BEMED trial 1, betahistine was found to have no significant effect on the mean number of vertigo attacks related to Ménière's disease compared to placebo, but it is still used to alleviate symptoms of tinnitus and vertigo. The medication works by improving microcirculation in the inner ear and reducing endolymphatic pressure, which can help alleviate existing tinnitus symptoms.

Key Points to Consider

• Betahistine is a histamine analog that primarily affects H1 and H3 receptors, improving blood flow to the inner ear structures 1.
• Some patients may experience mild side effects like headache, upset stomach, or allergic reactions, but tinnitus is not a commonly reported adverse effect 1.
• If someone experiences new or worsening tinnitus while taking betahistine, they should consult their healthcare provider as it may indicate an underlying condition or a need to adjust treatment.
• The BEMED trial 1 is a well-designed study that provides the best evidence available, and its findings suggest that betahistine may not be effective in reducing vertigo attacks, but it can still be used to treat tinnitus and other symptoms of Ménière's disease.

Treatment and Management

• Betahistine is usually prescribed at doses of 8-16 mg taken three times daily, with treatment often continuing for several months 1.
• Patients should be reassessed as often as clinically warranted for an improvement or stabilization of symptoms as well as to monitor for intolerance of medication or side effects 1.
• The clinician and patient should discuss titrating down or stopping the medication once the patient’s symptoms subside 1.

From the Research

Betahistine and Tinnitus

• The relationship between betahistine and tinnitus is complex, with some studies suggesting a potential benefit and others finding no significant effect 2, 3, 4.
• A 2018 Cochrane review found that betahistine had no significant effect on tinnitus loudness or symptom severity compared to placebo, with very low-quality evidence 2.
• In contrast, a 2011 study found that betahistine significantly improved tinnitus in patients with vestibular disorders, with 30.5% of patients experiencing clinical improvement 3.
• Other studies have found that betahistine may be useful in reducing vertigo attacks in patients with Menière's disease, but its effect on tinnitus is less clear 5, 6.

Adverse Effects

• Betahistine is generally well-tolerated, with a similar risk of adverse effects to placebo treatments 2, 4.
• Common adverse effects reported in studies include upper gastrointestinal discomfort, headache, drowsiness, and allergic skin reactions 2, 3.

Study Limitations

• Many studies on betahistine and tinnitus have methodological limitations, including small sample sizes, inadequate diagnostic criteria, and bias in methods 2, 4.
• Further research is needed to fully understand the effects of betahistine on tinnitus, using rigorous methodology and validated outcome measures 2, 6.