Histamine analogue, antivertigo agent
ATC code: N07CA01 (Betahistine)
A weak H1-receptor agonist and strong H3-receptor antagonist in the CNS. Proposed mechanism: improved inner-ear microcirculation and reduced endolymph pressure via stria vascularis vasodilation. Metabolized to inactive 2-pyridylacetic acid. Half-life 3–4 hours, dosed 2–3 times daily. -approved for Meniere's disease; has not approved it in the US.
First line
First-line for Meniere's disease to reduce vertigo attack frequency per EAONO/JOS 2015 and -HNS 2020. Standard dose 16 mg three times daily or 24 mg twice daily for 6–12 months. Evidence is conflicting: BEMED 2016 (221 patients) showed no benefit over placebo at 48 mg or 144 mg/day over 9 months. retained registration on historical data; has not approved it in the US.
Second line
Used symptomatically in peripheral vestibular vertigo. The 2016 Cochrane meta-analysis showed moderate effect on vertigo intensity and frequency versus placebo with low certainty. Not used in benign paroxysmal positional vertigo (BPPV) – otolith repositioning maneuvers are first-line there.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Betahistine is a histamine analogue prescribed for Meniere's disease and peripheral vestibular vertigo ( 2017 guidelines and AEMPS Ficha Técnica). Evidence quality for Meniere's disease is modest: the Cochrane review by Murdin 2016 found low-quality evidence. For cerebral circulation improvement or cognitive decline in older adults, betahistine is not used: no clinical studies of such use exist. Vascular cognitive dysfunction is managed not by vasodilators but by blood-pressure control, lipid management, smoking cessation, physical activity, and cognitive training. If betahistine was prescribed for memory improvement or brain circulation, consider seeking a second opinion.
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Limited pregnancy data. Use is not recommended.
No data. Not used during lactation.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Betahistine is evaluated for the following indications with varying evidence strength: Meniere's disease (evidence tier C), Vertigo (evidence tier C), Memory and concentration enhancement (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Betahistine (≥ 1 in 100): Nausea, dyspepsia, Headache, Warmth or flushing. See the Safety section for uncommon and serious reactions.
FDA category C. Limited pregnancy data. Use is not recommended.
No data. Not used during lactation.
Betahistine is contraindicated in: Betahistine hypersensitivity; Pheochromocytoma; Active peptic ulcer; Severe asthma (theoretical risk, rare in practice); Age under 18. Full list in the Safety section.