Betahistine is a drug which is commonly prescribed to patients suffering from vertigo, dizziness, unsteadiness or imbalance. It is often given to patients with Meniere’s disease which is a condition in which the pressure of the inner ear fluid is increased. The symptoms of Meniere’s disease consists of episodes of vertigo, hearing loss in one ear with a ringing sensation. Betahistine was first registered in 1970 for the treatment of Meniere’s disease. It is available under several brand names like Vertin, Betavert, B-stil, Betahist, Vertistar, Serc, Hiserk, Betaserc, Vergo etc.

The active ingredient of Betahistine is Betahistine hydrochloride or Betahistinedemesytate. Betahistine is one of the few drugs known which is said to improve the microcirculation of the inner ear. It works as a histamine analogue through 2 modes of action(1) agonist of H1 receptors and (2) antagonist of H3 receptors. It has a weak effect on H1 receptors but strong effect on H3 receptors. Studies have shown that by increasing the blood supply to the inner ear, both cochlear and vestibular parts, Betahistine may help in rebalancing the production and resorption of fluids within the inner ear system. By virtue of this effect, Betahistine is useful in the management of Meniere’s disease which is associated with endolymphatic hydrops or an increased endolymphatic pressure within the inner ear resulting in episodes of vertigo accompanied by tinnitus and fluctuating hearing loss. If Meniere’s disease is not treated appropriately and timely, it can progress to the permanent hearing loss in the affected ear with a persistent unsteadiness.

Betahistine does not cause drowsiness which is a common side effect of most vestibular suppressants used in vertigo management. Because of this action, it has less chance of jeopardizing the central compensation mechanism.

Recently some papers have also described the peripheral effects of betahistine on the balance organs of the ear. It is said to decrease the sensory input from this area thereby decreasing the excitatory response. Betahistine is different from other drugs used in vertigo management in that it does not suppress the working of the central nervous system which is important for recovery of vestibular disorders.

Betahistine is commercially available in strengths of 8, 16, 24 and 48 mg. It is said to have a dose-dependent effect which means the higher the dose it is given in, the more effective it would be.

Betahistine should be avoided or prescribed with caution in the following:

• Children below 18 years
• Pregnancy
• Lactation
• Bronchial Asthma
• Peptic ulcer
• Pheochromocytoma

Betahistine may cause allergies, skin-related hypersensitivity like tingling and numbness, shortness of breath and increased acidity due to raised histamine levels.

You should inform your doctor about all medications you are taking as drug interactions may occur with Betahistine. Betahistine is a histamine analogue which has an H1 receptor agonist and H3 receptor antagonist role. Due to this effect, it should not be given with H1 receptor antagonist like Cinnarizine as it will reduce the efficiency of both drugs.

Betahistine should be taken in the dosage prescribed by your doctor for the duration specified. Always inform your doctor about any pre-existing medical condition and share the following information:

• Any current medication you are taking
• Reports of the medical condition
• Any respiratory problems
• Any gastric or intestinal problems
• Allergy to any drugs

Betahistine is widely used in Europe and Asia. It is not available in the USA as it does not have FDA approval there.

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