From the Guidelines
Betahistine should be prescribed at a dose of 48 mg/d for chronic tinnitus, as this dose has been evaluated in a recent high-quality study 1. The use of betahistine for chronic tinnitus is based on its potential to improve inner ear microcirculation and reduce endolymphatic pressure.
- Key points to consider when prescribing betahistine include:
- Starting with a dose of 48 mg/d, as used in the BEMED trial 1
- Monitoring patients for improvement or stabilization of symptoms, as well as potential side effects such as headache, balance disorder, nausea, and upper gastrointestinal symptoms 1
- Using betahistine with caution in patients with asthma and history of peptic ulcer disease, and avoiding it in patients with pheochromocytoma 1
- Evaluating treatment response after 3-6 months, and considering discontinuation if no improvement is noted 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.
- However, the study provides valuable information on the safety and potential effectiveness of betahistine for chronic tinnitus, and its findings should be taken into consideration when making treatment decisions. It is essential to weigh the potential benefits and risks of betahistine treatment for each patient, and to discuss the uncertainties and limitations of the current evidence with them.
- By doing so, clinicians can make informed decisions that prioritize patient outcomes, including morbidity, mortality, and quality of life.
From the Research
Betahistine Dose for Chronic Tinnitus
- The optimal dose of betahistine for chronic tinnitus is not clearly established in the provided studies.
- A study from 2011 2 found that a daily dosage of 48 mg of betahistine for 120 consecutive days was useful in reducing or eliminating tinnitus in patients with vestibular disorders.
- However, a 2018 study 3 did not find significant evidence to support the use of betahistine for subjective idiopathic tinnitus, and the dose regimens used in the included studies were not specified.
- Other studies 4, 5, 6 focused on cognitive behavioral therapy (CBT) for tinnitus and did not provide information on betahistine dosing.
Key Findings
- Betahistine may be effective in reducing tinnitus in patients with vestibular disorders, but the evidence is limited 2.
- The quality of evidence for betahistine in treating subjective idiopathic tinnitus is low to very low 3.
- CBT may be an effective treatment option for tinnitus, with some evidence suggesting it can reduce the impact of tinnitus on quality of life 4, 5, 6.