Betahistine

How it works

It acts as a weak histamine H1-receptor agonist and a more potent H3-receptor antagonist, increasing inner-ear microcirculation and modulating vestibular nucleus activity.

Prescribing in practice

• Avoid in phaeochromocytoma and use with caution in asthma and active or historic peptic ulcer disease, as histaminergic activity may worsen these conditions.
• Theoretically antagonised by antihistamines, so review concurrent sedating antihistamine use that could blunt efficacy.
• Take with or after food to reduce gastric upset; clinical benefit may take several weeks to become apparent.

Monitoring

No routine laboratory monitoring is required; assess response by frequency and severity of vertigo attacks and review periodically.

Counselling the patient

• Take doses with food and continue regularly even if symptoms fluctuate.
• Report worsening wheeze, indigestion or abdominal pain.
• Benefit on vertigo may build gradually over weeks rather than immediately.

Evidence & guidelines

Betahistine is an established symptomatic treatment for Ménière's disease, though trial evidence for its efficacy remains modest and somewhat mixed.