Betahistine dihydrochloride

How it works

It acts as a weak histamine H1 agonist and H3 antagonist, thought to improve cochlear and vestibular microcirculation and modulate central vestibular signalling.

Prescribing in practice

• Use with caution in patients with active or a history of peptic ulcer disease, and in those with phaeochromocytoma; it should be avoided where there is known hypersensitivity.
• It may worsen symptoms in asthma, so monitor patients with asthma closely when starting treatment.
• Benefit develops gradually over weeks of regular dosing, so therapy should be given an adequate trial before judging response.

Monitoring

Monitor symptomatic response and tolerability over weeks; no routine laboratory monitoring is required.

Counselling the patient

• Take with or after food to reduce stomach upset.
• Improvement can take several weeks, so keep taking it regularly.
• Report worsening wheeze, indigestion or stomach pain.

Evidence & guidelines

Betahistine is widely used for Ménière's disease, though high-quality trial evidence for symptom control is limited and mixed.