Betahistine is indicated for the management of Ménière’s disease and Ménière-like syndromes, which are characterized by recurrent episodes of vertigo, tinnitus, and progressive hearing loss, often accompanied by nausea and vomiting.

Betahistine is a histamine analogue developed after the successful use of histamine in patients with Ménière’s syndrome. It relieves vertigo by improving microcirculation in the inner ear, thereby reducing pressure within the membranous labyrinth and alleviating symptoms associated with Ménière’s disease.

The mechanism of action of betahistine is multifactorial. Ménière’s disease is believed to result from an imbalance of endolymphatic fluid in the inner ear. Betahistine primarily acts as a histamine H1-receptor agonist, causing vasodilation in the inner ear, increasing vascular permeability, and reducing endolymphatic pressure. This helps prevent damage to the labyrinth and associated hearing loss. It also improves vestibular function by reducing asymmetry between sensory vestibular organs and increasing blood flow to the vestibulocochlear system, thereby reducing vertigo symptoms.

Additionally, betahistine acts as a histamine H3-receptor antagonist, increasing histamine release and enhancing H1-mediated activity. This leads to increased levels of neurotransmitters such as serotonin in the brainstem, helping to regulate vestibular function and improve balance.

No clinically significant hazardous interactions have been firmly established. However, isolated reports suggest possible interaction with alcohol and with combinations containing pyrimethamine and dapsone. Potentiation of betahistine has also been reported with salbutamol. Since betahistine is a histamine analogue, concomitant use with H1-antihistamines may reduce the effectiveness of both agents.

Betahistine is contraindicated in patients with phaeochromocytoma, as it may trigger catecholamine release and cause severe hypertension. It is also contraindicated in patients with known hypersensitivity to betahistine or any of its components.

Caution is advised in patients with a history of peptic ulcer due to possible dyspepsia. It should also be used carefully in patients with bronchial asthma.

Patients with allergic conditions such as urticaria, rash, or allergic rhinitis should be monitored, as symptoms may worsen. Caution is required in patients with severe hypotension.

Patients with rare hereditary conditions such as galactose intolerance, Lapp lactase deficiency, or glucose-galactose malabsorption should avoid this medication.

Effects on driving and machinery: Rare cases of drowsiness have been reported. Patients experiencing such effects should avoid driving or operating machinery.

Symptoms of overdose may include nausea, vomiting, indigestion, ataxia, and seizures. Severe complications such as convulsions or cardiopulmonary effects may occur in cases of intentional overdose, especially when combined with other drugs. There is no specific antidote. Management includes gastric lavage and symptomatic treatment.

Drugs used in Ménière’s disease.

Store below 30°C, protected from light and moisture. Keep out of reach of children.