Betahistine: Indications and Precautions

When administering betahistine, doctors need to be cautious in patients with bronchial asthma and/or a history of peptic ulcer.

Betahistine is a pharmaceutical histamine regulator that’s been used to treat vertigo for about 40 years. Other indications have also been studied, such as the treatment of Ménière’s disease and benign paroxysmal positional vertigo (BPPV).

Its mechanism of action in Ménière’s disease and BPPV isn’t entirely clear. According to many experts, it prevents the worsening of this condition and prevents progressive hearing loss. In BPPV, it’s used as an adjuvant therapy for vestibular compensation in recurring cases of the disease.

On the other hand, the causes of Ménière’s disease, BPPV, and other types of peripheral vertigo remain a mystery. For this reason, experts don’t know the exact mechanism by which betahistine or other pharmaceuticals that treat these disorders work.

What is vertigo?

Vertigo isn’t a disease, but rather a symptom. Patients who suffer from it experience a false sensation of motion. It usually occurs frequently and can interfere with patients’ daily lives.

As we’ve mentioned, at present it’s not well understood why this symptom occurs. Experts believe that this type of vertigo originates in the acoustic labyrinth of the inner ear, and not in the corresponding neuronal connections.

Treatment for vertigo requires a multidisciplinary approach that normally includes:

• Pharmacological treatment
• Physical therapy sessions
• Lifestyle changes

What about Meniere’s disease?

This disease is a condition that affects the patient’s inner ear. It involves episodes of dizziness or vertigo and loss of hearing. In addition, it normally only affects one of the ears.

The physiopathology of this disease involves an imbalance in fluids, which leads to changes in lymphatic pressure in the region of the inner ear.

Furthermore, a patient can develop Meniere’s disease at any age. However, statistics show that it most commonly occurs between early adulthood and middle age.

Despite being considered a chronic illness, treatments are available nowadays to alleviate symptoms and improve long-term quality of life. Furthermore, experts think betahistine acts on the capillaries of the inner ear.

Therefore, this medication helps to reduce the pressure in the endolymphatic space, and helps in the reabsorption of endolymphatic fluid (endolymph).

Main symptoms

This disease involves a series of signs and symptoms. Among them, we’ll mention:

• Vertigo. This can cause nausea.
• Hearing loss. It can come and go, especially at the beginning. Over time, patients also usually end up losing their hearing permanently.
• Tinnitus. This is the sensation of hearing ringing or buzzing in the ears.
• Sensation of auditory congestion, or feeling like the ear is plugged.

However, following an episode, the signs and symptoms of this disease usually disappear completely for some time. Additionally, these episodes tend to occur less frequently over time.

How does betahistine work in the body?

Betahistine is effective because of its ability to regulate the body’s histaminergic system. It’s a histamine H3 receptor antagonist, as well as a histamine H1 receptor agonist. However, it has almost no effect on histamine H2 receptors.

Once it’s administered, it reaches the inner ear and increases the release of neurotransmitters from the nerve endings there. As a result of its interaction with histamine H1 receptors, it produces a strong vasodilator effect in the inner ear. In this way, it improves the clinical profile of peripheral vertigo.

Warnings and adverse reactions to betahistine

When doctors administer this medication, they need to be careful in patients with bronchial asthma and/or a history of peptic ulcers.

Additionally, pregnant or lactating women shouldn’t take betahistine, since there are no studies on this medication’s effects under these circumstances.

Regarding adverse reactions for this medication, it’s important to note the following:

• Gastrointestinal problems
• Disorders of the nervous system
• Immunologic disorders
• Problems with skin and subcutaneous tissue

Conclusion

Betahistine has been used for a long time to effectively treat vertigo. However, just like any medicine, it’s not free from possible adverse effects. Therefore, it’s important to always follow your doctor’s instructions, and avoid self-medicating. 

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