Betahistine

How it works

It acts as a weak histamine H1-receptor agonist and H3-receptor antagonist; it is thought to improve microcirculation in the inner ear and modulate vestibular activity, although the precise mechanism is not fully established.

Prescribing in practice

• Use with caution in asthma and in active or previous peptic ulcer disease, as histaminergic effects may provoke symptoms.
• Use caution in phaeochromocytoma; it is generally well tolerated, with mild gastrointestinal upset and headache the commonest effects.
• Review the response over time and reconsider the diagnosis or treatment if vertigo is not controlled.

Monitoring

No specific laboratory monitoring is required; assess clinically by the frequency and severity of vertigo, tinnitus and hearing symptoms.

Counselling the patient

• Take it with food to reduce stomach upset.
• Report worsening wheeze if you have asthma, or indigestion or stomach pain.

Evidence & guidelines

Widely used to reduce the burden of Ménière's-related vertigo; benefit is supported by clinical use and guidance, though trial evidence is mixed.