Does betahistine help in treating vertigo (dizziness)?

From the Guidelines

Betahistine does not provide a significant benefit in treating vertigo (dizziness) as compared to a placebo, according to the most recent and well-designed study, the BEMED trial 1. The BEMED trial, a double-blind RCT, evaluated the effect of betahistine on vertigo attacks in patients with Ménière's disease and found no significant differences in mean attack rate per 30 days between the placebo and betahistine groups 1. Key points to consider when deciding to use betahistine include:

• The lack of significant differences in vertigo attacks between betahistine and placebo groups 1
• The potential side effects of betahistine, such as headache, balance disorder, nausea, and upper gastrointestinal symptoms 1
• The need to use betahistine with caution in patients with asthma, history of peptic ulcer disease, and avoided in patients with pheochromocytoma 1
• The importance of reassessing patients regularly for improvement or stabilization of symptoms, as well as monitoring for intolerance or side effects 1

From the Research

Effectiveness of Betahistine in Treating Vertigo

• Betahistine has been shown to be effective in reducing vertigo symptoms in patients with different types of vertigo, including Meniere's disease, benign paroxysmal positional vertigo (BPPV), and vestibular neuronitis 2, 3, 4, 5, 6.
• A meta-analysis of 17 studies found that betahistine was more effective than a placebo in reducing vertigo symptoms, with a risk ratio of 1.30 (95% CI 1.05 to 1.60) 2.
• Another study found that betahistine was effective in reducing the frequency and duration of vertigo attacks in patients with Meniere's disease, with a statistically significant decrease in frequency of dizziness (P = .000331) and vertigo (P < .00001) 6.
• Betahistine has also been shown to be effective in reducing vertigo symptoms in patients with BPPV, with a study finding that it was effective in reducing the severity of vertigo during repositioning maneuvers 3.

Safety and Tolerability of Betahistine

• Betahistine is generally well tolerated, with a low risk of adverse events 2, 4.
• A study found that the most common adverse effects of betahistine were gastrointestinal symptoms and headache, but these were rare and medically serious events were isolated 2.
• Another study found that betahistine had an excellent safety profile, with no significant differences in adverse effects compared to a placebo 4.

Dosage and Treatment Duration

• The optimal dosage and treatment duration of betahistine for vertigo symptoms are not well established, but studies have found that a daily dose of 48 mg for 3 months is effective and safe 2, 4.
• A study found that the mean dose of betahistine used in symptomatic treatment was 87.5 ± 27.2 mg per day, but there was no connection detected between the dose of the agent and the effectiveness of the symptomatic control 6.
• Another study found that a once-daily drug formulation of modified-release betahistine was non-inferior to traditional betahistine and had a comparable safety profile 3.