From the Guidelines
Betahistine is not recommended for the treatment of vertigo due to its lack of efficacy in reducing vertigo attacks, as shown in the most recent and well-designed study, the BEMED trial 1. The BEMED trial, a double-blind RCT, found that low-dose and high-dose betahistine did not significantly reduce the mean number of vertigo attacks compared to placebo in patients with Ménière's disease 1. This study's findings contradict the 2016 Cochrane SR, but its well-designed methodology makes it a more reliable source of evidence. Some key points to consider when evaluating betahistine for vertigo treatment include:
- The medication's efficacy in reducing vertigo attacks is not supported by the most recent evidence 1
- Betahistine may still be considered for use in patients with vertigo, but its benefits and risks should be carefully weighed, particularly in patients with asthma, peptic ulcer disease, or pheochromocytoma 1
- Common side effects of betahistine include headache, balance disorder, nausea, and upper gastrointestinal symptoms, although serious medical side effects are rare 1
- The optimal treatment duration for betahistine is unclear, with most studies covering only a short period, but the BEMED trial suggests that even a 9-month treatment window may not be effective in reducing vertigo attacks 1
From the Research
Efficacy of Betahistine for Vertigo
- Betahistine has been demonstrated to be effective and safe in the treatment of Ménière's disease, BPPV (benign paroxysmal positional vertigo), vestibular neuronitis, and other types of peripheral vertigo 2.
- A meta-analysis of 12 double-blind, randomized, placebo-controlled clinical studies found that betahistine had a statistically significant effect on vertigo symptoms in patients with vestibular vertigo or Ménière's disease, with an odds ratio of 2.58 (95% confidence interval 1.67-3.99) 3.
- A study comparing the efficacy and safety of modified-release betahistine (48 mg once daily) versus betaserc (24 mg twice daily) in patients with Meniere's disease or vestibular vertigo found that betahistine MR was non-inferior to betaserc and had a comparable safety profile 4.
Dosage and Administration
- Betahistine can be administered at a dose of 16 mg tid or 24 mg bid, with similar efficacy and tolerability in the treatment of vertigo in patients with Ménière's disease 5.
- A dose of 48 mg daily for 3 months has been shown to be an effective and safe option for the treatment of peripheral vertigo 2.
- Modified-release betahistine (48 mg once daily) has been found to be non-inferior to betaserc (24 mg twice daily) in patients with Meniere's disease or vestibular vertigo 4.
Mechanism of Action
- The precise mechanism of action of betahistine is still not completely understood, but it is thought to involve the central nervous system and the neuronal systems involved in the recovery from process after vestibular loss 6.
- Betahistine has been found to have weak agonist properties at histamine H1 receptors and more potent antagonistic effects at histamine H3 receptors, and is thought to act on the histaminergic neurones of the tuberomamillary and vestibular nuclei 6.
Safety Profile
- Betahistine has been shown to have an excellent safety profile, with a low incidence of adverse events, including headache, in clinical trials 2, 4, 5.
- The safety profile of betahistine MR (48 mg once daily) has been found to be comparable to that of betaserc (24 mg twice daily) in patients with Meniere's disease or vestibular vertigo 4.