Betahistine in Meniere's Disease Treatment

Introduction to Betahistine Treatment

The American Academy of Otolaryngology-Head and Neck Surgery cannot definitively recommend betahistine for Meniere's disease due to the BEMED trial showing no significant difference between betahistine and placebo in reducing vertigo attacks 1, 2

Two dosage regimens of betahistine have been studied for Meniere's disease: low-dose (48 mg/day) and high-dose (144 mg/day) 1, 2
The American Academy of Otolaryngology-Head and Neck Surgery suggests that treatment duration may vary, with most studies covering 2-12 weeks and the BEMED trial using a 9-month treatment period 1, 2

The 2020 American Academy of Otolaryngology-Head and Neck Surgery clinical practice guideline states they are unable to make a definitive statement on the use of betahistine to control Meniere's disease symptoms 1
A 2016 Cochrane systematic review suggested a benefit with betahistine, reporting a 56% reduction in vertigo compared to placebo, but the more recent BEMED trial found no significant differences between betahistine and placebo 1, 3

Betahistine is contraindicated in patients with pheochromocytoma and should be used with caution in patients with asthma and a history of peptic ulcer disease 1, 5
Common side effects of betahistine include headache, balance disorder, nausea, nasopharyngitis, feeling hot, eye irritation, palpitations, and upper gastrointestinal symptoms 1, 2
Patients should be reassessed as clinically warranted for symptom improvement and medication side effects 1, 2