Betahistine

How it works

It acts as a histamine H1 agonist and H3 antagonist, thought to improve microcirculation in the inner ear (stria vascularis) and modulate vestibular activity, reducing endolymphatic pressure.

Prescribing in practice

• In older patients caution applies in active or past peptic ulcer disease and in asthma, as betahistine may aggravate these conditions.
• It is best taken with food to reduce gastrointestinal upset.
• Benefit on Meniere's symptoms is modest and variable, so review effectiveness and avoid attributing all balance problems in older people to a single cause.

Monitoring

Monitor clinically for change in vertigo frequency and severity and for gastrointestinal or respiratory adverse effects.

Counselling the patient

• Take it with or after food.
• Report worsening indigestion, stomach pain or wheeze.
• Effects build over time and the medicine controls rather than cures symptoms.

Evidence & guidelines

Evidence for symptom benefit in Meniere's disease is limited and mixed, and use reflects the product SPC and specialist practice rather than a definitive landmark trial.