Betahistine is a histamine analogue medication specifically designed to address vestibular dysfunction, a primary cause of vertigo and associated balance disorders. It functions by improving blood flow in the inner ear and reducing pressure in the endolymphatic system, which is often implicated in conditions like Ménière’s disease. This targeted mechanism helps restore equilibrium and reduce the frequency and severity of dizzy spells, offering patients a path toward functional improvement and enhanced quality of life. Clinical use is supported by evidence demonstrating its efficacy in symptom management for appropriate candidates.

Features

• Active ingredient: Betahistine dihydrochloride
• Pharmacological class: Histamine H₁ receptor agonist and H₃ receptor antagonist
• Available in tablet form (typically 8 mg, 16 mg, 24 mg)
• Improves microvascular circulation in the inner ear
• Reduces endolymphatic pressure
• Prescription-only medication in most regions

Benefits

• Reduces frequency and intensity of vertigo attacks
• Improves overall balance and spatial orientation
• Decreases associated symptoms such as nausea and tinnitus in some patients
• Supports long-term management of chronic vestibular conditions
• Enhances daily functioning and reduces fall risk
• May help prevent progressive hearing loss in Ménière’s disease

Common use

Betahistine is primarily indicated for the treatment of vertigo and related symptoms stemming from vestibular disorders, most notably Ménière’s disease. It is also used off-label in other conditions involving vestibular dysfunction, such as vestibular neuritis or benign paroxysmal positional vertigo (BPPV), when other first-line treatments are ineffective or poorly tolerated. It is not intended for motion sickness or non-vestibular causes of dizziness. Diagnosis and treatment planning should always be supervised by a specialist, such as a neurologist or otolaryngologist.

Dosage and direction

The typical starting dose for adults is 8–16 mg taken orally three times daily, though dosage may be adjusted based on individual response and tolerability. For Ménière’s disease, maintenance doses often range from 24 mg to 48 mg per day, divided into two or three administrations. Tablets should be taken with water, with or after food to minimize potential gastrointestinal discomfort. Dosage adjustments are necessary in patients with renal impairment, asthma, or peptic ulcer history. Always follow the prescribing physician’s instructions—do not self-adjust.

Precautions

Use with caution in patients with a history of peptic ulcers or gastrointestinal bleeding. Asthmatic patients should be monitored closely due to betahistine’s histaminergic activity. Renal impairment may require dose reduction. Use during pregnancy only if clearly needed and under medical supervision—animal studies show no teratogenic effects, but human data are limited. Betahistine is excreted in breast milk; consider discontinuing nursing or the drug depending on clinical need. Avoid abrupt discontinuation.

Contraindications

Betahistine is contraindicated in patients with known hypersensitivity to betahistine or any component of the formulation. It should not be used in patients with pheochromocytoma due to theoretical risk of catecholamine release. Avoid in those with uncontrolled asthma or active peptic ulcer disease. Not recommended in children under 18 years due to insufficient safety and efficacy data.

Possible side effects

Common side effects (≥1/100) include:

• Nausea
• Dyspepsia
• Headache

Less common side effects (≥1/1000, <1/100) may include:

• Mild skin reactions (rash, pruritus)
• Abdominal pain
• Bloating

Rare adverse reactions (<1/1000) include:

• Hypersensitivity reactions
• Worsening of asthma symptoms
• Gastrointestinal bleeding (in predisposed patients)

Most side effects are mild and transient. Discontinue and seek medical advice if severe reactions occur.

Drug interaction

Betahistine may interact with:

• Antihistamines: may reduce efficacy
• Monoamine oxidase inhibitors (MAOIs): theoretical risk of increased blood pressure
• Drugs affecting gastric pH (e.g., proton pump inhibitors): possible altered absorption
• Other vestibular suppressants: may mask therapeutic effects

Always inform your physician of all medications, including over-the-counter drugs and supplements.

Missed dose

If a dose is missed, take it as soon as remembered unless it is nearly time for the next dose. Do not double the dose to catch up. Maintaining consistent blood levels is important for efficacy, so try to adhere to the prescribed schedule. Use a pill organizer or alarm reminders if forgetfulness is recurrent.

Overdose

Symptoms of overdose may include nausea, vomiting, abdominal discomfort, hypotension, or drowsiness. There is no specific antidote. Treatment is supportive and symptomatic. Gastric lavage or activated charcoal may be considered if ingestion was recent. Contact a poison control center or emergency department immediately if overdose is suspected.

Storage

Store at room temperature (15–30°C), in the original container, protected from light and moisture. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Do not dispose of medication in wastewater or household waste—return unused portions to a pharmacy or use a take-back program.

Disclaimer

This information is intended for educational purposes and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before starting or changing any medication regimen. Individual response to betahistine may vary. Not all uses or precautions are covered here—follow your prescriber’s guidance.

Reviews

Clinical studies and meta-analyses generally support the use of betahistine for reducing vertigo frequency in Ménière’s disease, though evidence quality varies. Many patients report significant improvement in symptoms and quality of life with continued use. Some individuals may experience limited benefit or require adjunct therapies. Long-term tolerability is generally good. Always discuss treatment expectations and progress with your healthcare provider.