Skip to main content
Article thumbnail
Location of Repository

Betahistine in the treatment of Ménière’s disease

By Michel Lacour, Paul H van de Heyning, Miroslav Novotny and Brahim Tighilet


Ménière’s disease and related disease of the vestibular system are common and debilitating. Current therapy is multi-modal and includes drug therapy and lifestyle adaptations. Unfortunately many of the drugs used in treatment (particularly those used to control nausea) are sedative and hamper the process of vestibular compensation. Although betahistine (Serc®, BetaSerc®; Solvay Pharmaceuticals) is the mainstay of drug treatment in these illnesses, its efficacy has not, until recently, been evaluated to modern standards. Betahistine is an analog of histamine with weak agonist properties at histamine H1 receptors and more potent anatgonistic effects at histamine H3 receptors. Growing evidence suggests that the mechanism of action of betahistine lies in the central nervous system and in particularly in the neuronal systems involved in the recovery from process after vestibular loss. The histaminergic neurones of the tuberomamillary and vestibular nuclei are implicated. In recent years the clinical efficacy of betahistine has been demonstrated in double-blind, randomized, placebo, and active controlled studies in adequate numbers of patients. Although the results of comparative studies between betahistine and other drugs (flunarizine, cinnarizine, and cinnarizine + dimenhydrate) are equivocal, the efficacy of betahistine is now clear

Topics: Expert Opinion
Publisher: Dove Medical Press
OAI identifier:
Provided by: PubMed Central

Suggested articles


  1. 1990.Characteristics of self-reported hearing problems in a community survey.
  2. (1986). A double-blind crossover study comparing betahistine and cinnarizine in the treatment of recurrent vertigo in patients in general practice.
  3. (2005). A national survey amongst UK otolaryngologists regarding the treatment of Ménière’s disease.
  4. (2000). A review of medical treatment for Meniere’s disease. Acta Otolaryngol Suppl,
  5. (1990). A third histaminergic receptor subtype: characterisation, location and functions of the H3-receptor. Agents Actions,
  6. (1985). Actions of betahistine at histamine receptors in the brain.
  7. (1995). Antivertigo medications and drug-induced vertigo.
  8. (1983). Auto-inhibition of brain histamine release mediated by a novel class H3. of histamine receptor.
  9. (1987). Autoregulation of histamine synthesis in brain mediated by presynaptic H3 receptors.
  10. (2003). Betahistine dihydrochloride in the treatment of peripheral vestibular vertigo. Eur Arch Otorhinolaryngol,
  11. (1984). Betahistine dihydrochloride in the treatment of vertigo of peripheral vestibular origin. A double-blind placebo-controlled study.
  12. (2002). Betahistine dihydrochloride interaction with the histaminergic system in the cat: neurochemical and molecular mechanisms.
  13. (1995). Betahistine dihydrochloride treatment facilitates vestibular compensation in the cat.
  14. (1991). Betahistine dihydrochloride versus fl unarizine. A double-blind study on recurrent vertigo with or without cochlear syndrome typical of Ménière’s disease. Acta Otolaryngol Suppl,
  15. (2001). Betahistine in the treatment of vertigo. History and clinical implications of recent pharmacological researches. Acta Otorhinolaryngol Ital,
  16. (1993). Betahistine-induced vascular effects in the rat cochlea.
  17. (2006). Changes in histaminergic system during vestibular compensation in the cat. J Physiol Lond, In press.
  18. (1996). Characteristics of six otologic diseases involving vertigo.
  19. (2004). Cochlear aqueduct fl ow resistance depends on round window membrane position in guinea pigs.
  20. (2002). Cochlear ultrastructure in two-phase endolymphatic hydrops in the guinea-pig. Eur Arch Otorhinolaryngol,
  21. (1995). Committee on hearing and equilibrium.
  22. (1980). Compensation des défi cits posturaux et cinétiques après neurectomie vestibulaire unilatérale chez le chat. Rôle de l’activité sensorimotrice. Acta Otolaryngol,
  23. (1976). Controlled clinical trial comparing the effect of betahistine hydrochloride and prochlorperazine maleate on patients with Ménière’s disease. Ann Clin Res,
  24. (1990). Curious oddments of auditory-nerve studies. Hear Res,
  25. (2002). Defi cits and recovery of head and trunk orientations and stabilization after unilateral vestibular loss.
  26. (1991). desynchrony between complaints and signs of vestibular disorders. Acta Otolaryngol,
  27. (2004). Direct measurement of the fl ow resistance of the aqueduct in the guinea pig. Acta Otolaryngol,
  28. (1996). Distribution of histaminergic axonal fi bres in the vestibular nuclei of the cat.
  29. (2005). Dose and duration-dependent effects of betahistine dihydrochloride treatment on histamine turnover in the cat.
  30. (2003). Double-blind, randomized, multicenter study comparing the effect of betahistine and fl unarizine on the dizziness handicap in patients with recurrent vestibular vertigo. Acta Otolaryngol,
  31. (2002). Early vestibular rehabilitation in patients with Meniere’s disease.
  32. (1987). Effect of betahistine dihydrochloride on induced vestibular nystagmus: a double blind study. Clin Otolaryngol Allied Sci,
  33. (1993). Effect of unilateral vestibular stimulation on histamine release from the hypothalamus of rats
  34. (1998). Effects of betahistine on vestibular receptors of the frog.
  35. (1971). Effects of diphenhydramine and dimenhydrinate on vestibular neuronal activity of cat: a search for the locus of their antimotion sickness action.
  36. (1995). Effects of histamine and betahistine on rat medial vestibular nucleus neurones: possible mechanism of action of anti-histaminergic drugs in vertigo and motion sickness. Exp Brain Res,
  37. (1989). Effects of histamine H3 receptor ligands on various biochemical indices of histaminergic neuron activity in rat brain.
  38. (1993). Effects of histamine on rat medial vestibular nucleus neurones in vitro.
  39. (2005). Effi cacy and tolerability of a fi xed combination of cinnarizine and dimenhydrinate versus betahistine in the treatment of otogenic vertigo: a double-blind, randomised clinical study. Clin Drug Invest,
  40. (2002). Fixed combination of cinnarizine and dimenhydrinate versus betahistine dimesylate in the treatment of Ménière’s disease: a randomized, double-blind, parallel group clinical study.
  41. (1988). Flunarizine and betahistine. Two different therapeutic approaches in vertigo compared in a double-blind study. Acta Otolaryngol Suppl,
  42. (1999). Fos expression in the cat brainstem after unilateral vestibular neurectomy. Brain Res,
  43. (2004). Glucocorticoids stimulate cation absorption by semicircular canal duct epithelium via epithelial sodium channel.
  44. (1992). H3-receptors and control of histamine release.
  45. (2005). Histamine (H3) receptors modulate the excitatory amino acid receptor response of the vestibular afferents.
  46. (1991). Histamine agonists and antagonists. Acta Otolaryngol Suppl,
  47. (2001). Histamine and betahistine in the treatment of vertigo: elucidation of mechanisms of action.
  48. (1990). Histamine depolarizes rat medial vestibular nucleus neurons recorded intracellularly in vitro.
  49. (1997). Histamine immunoreactivity changes in vestibular-lesioned and histaminergic-treated cats.
  50. (1991). Histamine in the treatment of vertigo.
  51. (1987). Histamine neuronal pathways and their function. Trends Neurosci,
  52. (1989). Histamine-immunoreactive nerve fi bers in the rat brain.
  53. (2001). Impact of Ménière’s disease on quality of life.
  54. (2005). Incidence of virus infection as a cause of Ménière’s disease or endolymphatic hydrops assessed by electrocochleography.
  55. (1988). Indicators of the influence a peripheral vestibular deficit has on vestibulo-spinal reflex responses controlling postural stability. Acta Otolaryngol,
  56. (2004). Intralabyrinthine fl uid dynamics: Meniere disease. Curr Opin Otolaryngol Head Neck Surg,12:408–12.
  57. (2004). Intratympanic perfusion for the treatment of tinnitus.
  58. (2004). Intratympanic steroid treatment: a review. Otol Neurotol,
  59. (1989). Linear acceleration perception in the roll plane before and after unilateral vestibular neurectomy. Exp Brain Res,
  60. (1997). Long-term effects of Ménière’s disease on hearing and quality of life.
  61. (2000). Long-term evolution of subjective visual vertical after vestibular neurectomy and labyrinthectomy. Acta Otolaryngol,
  62. (1979). Mammalian vestibular physiology.
  63. (1989). Mechanisms of recovery following unilateral labyrinthectomy: a review. Brain Res Brain Res Rev,
  64. (1993). Medial vestibular nucleus in the guinea-pig: histaminergic receptors. II. An in vivo study. Exp Brain Res,
  65. (1997). Medical therapy of Ménière’s disease : a review of literature. Acta Otolaryngol Suppl,
  66. (1984). Ménière´s disease: a 30-year epidemiologic and clinical study
  67. (1967). Ménière’s disease and hydrochlorothiazide (Dichlotride)—a critical analysis of symptoms and therapeutic effects. Acta Otolaryngol,
  68. (1954). Ménière’s disease.
  69. (1997). Natural history of Méniere´s disease: staging the patients or their symptoms? Acta Otolaryngol Suppl,
  70. (2004). Paroxetine, a selective serotonin reuptake inhibitor, reduces depressive symptoms and subjective handicaps in patients with dizziness.
  71. (2003). Perilymphatic and endolymphatic pressure during endolymphatic hydrops. Eur Arch Otorhinolaryngol,
  72. (2005). Physiopathology of ménière’s syndrome: are symptoms caused by endolymphatic hydrops? Otol Neurotol,
  73. (2004). Progression of symptoms of dizziness in Ménière’s disease. Arch Otolaryngol Head Neck Surg,
  74. (2005). Surgical treatment of Ménière’s disease.
  75. (1994). Système histaminergique central et états de vigilance chez le chat. Thèse Doct Sciences, Université Claude Bernard,
  76. (1984). The anatomy and physiology of vestibular system.
  77. (1997). The dose-dependent effect of betahistine on vestibulo-ocular refl ex: a double-blind, placebo controlled study in patients with paroxysmal vertigo.
  78. (1991). The effects of two antivertigo drugs betahistine and prochlorperazine. on driving skills.
  79. (1988). The histaminergic system in the guinea pig central nervous system: an immunocytochemical mapping study using an antiserum against histamine.
  80. (1990). The human horizontal vestibulo-ocular refl ex in response to high-acceleration stimulation before and after unilateral vestibular neurectomy. Exp Brain Res,
  81. (1996). The infl uence of betahistine on the vestibular evoked potentials in patients with peripheral vestibular disorders.
  82. (1936). The otolythic catastrophe: a new syndrome.
  83. (1997). The prevalence of defi nite cases of Méniere´s disease.
  84. (1998). The vascular mechanisms of action of betahistine in the inner ear of the guinea pig. Eur Arch Otorhinolaryngol,
  85. (1996). Tilt suppression, OKAN, and head-shaking nystagmus at long-term follow-up after unilateral vestibular neurectomy.
  86. (2005). Torsional optokinetic nystagmus after unilateral vestibular loss: asymmetry and compensation.
  87. (2004). Treatment of vertigo due to acute unilateral vestibular loss with a fi xed combination of cinnarizine and dimenhydrinate: a double-blind, randomized, parallel-group clinical study. Clin Ther,
  88. (1990). Trimetazidine versus betahistine in Ménière’s disease. A double blind method. Ann Otolaryngol Chir Cervicofac,
  89. (1990). Trimetazidine versus betahistine in vestibular vertigo. A double blind study. Ann Otolaryngol Chir Cervicofac,
  90. (1997). Two-phase endolymphatic hydrops: a new dynamic guinea pig model. Acta Otolaryngol,
  91. (1986). Use of a diuretic (Dyazide) in the treatment of Ménière’s disease. A double-blind cross-over placebocontrolled study.
  92. (1989). Vestibular compensation. Facts, theories and clinical perspectives.
  93. (1993). Vestibular control of posture and gait.
  94. (1997). Vestibular rehabilitation strategies in Meniere’s disease.
  95. (2004). Walking performance of vestibulardefective patients before and after unilateral vestibular neurotomy. Behav Brain Res,

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.