Betahistine in the Treatment of Peripheral Vestibular Vertigo: Results of a Real-Life Study in Primary Care

Abstract

The present research was carried out with the objective to establish the clinical effect and safety of betahistine (48 mg daily), for the management of peripheral vestibular vertigo, in patients treated by primary care physicians in Colombia. An observational prospective cohort study was conducted including patients older than 15 years with clinical diagnosis of peripheral vestibular vertigo who were candidates to be treated with betahistine (48 mg daily). A sample size of 150 individuals was calculated, and weekly follow-ups were planned for 12 weeks. Rotatory movement sensation, loss of balance, and global improvement scale from 0 to 100 points were evaluated. Complete improvement was defined when the patient reached a level of 100 points. We calculated average weekly improvement, cumulative incidence of complete improvement, incidence rate of complete improvement, and the probability of complete improvement as a function of time. After the first week, the average improvement was 56.6 points (95% confidence interval [CI]: 50.4-62.7). At the end of week 12, it was 89.3 points (95% CI: 86.5-92.2). Sixty-one percent of the patients had achieved complete improvement at the end of the second week. After the sixth week, the percentage of cumulative improvement was 72%, and after 12 weeks of follow-up, the cumulative incidence of complete improvement was 73% (95% CI: 65%-80%). Based on the follow-up times, a complete improvement incidence rate of 16 cases per 100 people/week was calculated (95% CI: 13-19). We concluded that Betahistine (48 mg daily) has a positive effect, controlling the symptoms associated with benign paroxysmal vertigo, with an adequate safety profile.

Dose- and application route-dependent effects of betahistine on behavioral recovery and neuroplasticity after acute unilateral labyrinthectomy in rats

“…While a general therapeutic effect of betahistine in acute peripheral vestibular syndrome was indicated by studies in various animal models ( 33 – 35 ), the verdict on the strength of this effect seems to vary ( 36 ). The key to understanding the potentially ambiguous effects of betahistine seems to be its specific metabolism and pharmacokinetic properties.…”

Medical Treatment Approaches in Vestibular Disorders: A Descriptive Cross-Sectional Study

“…The positive effect of betashistine on symptom relief has been well studied in previous studies. 15,19 Della Pepa et al indicated the importance of objective physical examination and laboratory findings on treatment planning with be- 20 However, in a study conducted with 13 countries, it was shown that two-thirds of the subjects diagnosed with vertigo were prescribed betahistine as a result of the initial evaluation, regardless of the etiology. 21 In our study, consistent with the literature, clinicians mostly decide the treatment plan according to the general symptoms of the patients rather than objective laboratory findings.…”

“…17 Although repositioning maneuvers (RPM) are generally preferred in the treatment, it has been observed in various studies that combined treatment with drugs has better outcomes. 8,14,[18][19][20] As a result of our study, it was observed that 44.8% of the participants tended to apply RPM alone, while 22.7% prefer medical treatment and RPM together in the treatment of BPPV.…”

Current definition, diagnosis, and treatment of canine and feline idiopathic vestibular syndrome

“…As an agonist of the histamine H1 receptor and antagonist of the histamine H3 receptor, it reduces activation of the vestibular nuclei and increases cerebral blood flow through vasodilation. This mechanism is believed to improve central compensation for vertigo (21,(64)(65)(66). Various dosages ranging from 2 mg/kg to 100 mg/kg have been reported in the literature, each showing positive effects on vertigo but not specifically in patients with IVS (67,68).…”