The site of the Media Sphera Publishers contains materials intended solely for healthcare professionals.
By closing this message, you confirm that you are a certified medical professional or a student of a medical educational institution.

Zamergrad M.V.

Russian Medical Academy of Continuous Professional Education;
Russian Gerontology Clinical Research Center of Pirogov Russian National Research Medical University

Kunelskaya N.L.

L. I. Sverzhevsky Research Clinical Institute of Otorhinolaryngology;
Pirogov Russian National Research Medical University

Guseva A.L.

Pirogov Russian National Research Medical University

Amelin A.V.

Pavlov First Saint Petersburg State Medical University

Lilenko S.V.

Saint Petersburg ENT and Speech Research Institute;
North-Western State Medical University named after I.I. Mechnikov

Samartcev I.N.

Kirov Military Medical Academy

Zaytseva O.V.

Scientific and Clinical Center of Otorhinolaryngology of the Federal Medico-Biological Agency of the Russian Federation

Melnikov O.A.

Center of vertigo and balance disorders, GUTA CLINIC

Voronov V.A.

North-Western State Medical University named after I.I. Mechnikov

Lyapin A.V.

Federal Siberian Research Clinical Centre under the Federal Medical Biological Agency

Betahistine in vestibular disorders: current concepts and perspectives

Authors:

Zamergrad M.V., Kunelskaya N.L., Guseva A.L., Amelin A.V., Lilenko S.V., Samartcev I.N., Zaytseva O.V., Melnikov O.A., Voronov V.A., Lyapin A.V.

More about the authors

Journal: Russian Bulletin of Otorhinolaryngology. 2021;86(2): 73‑81

Read: 38397 times


To cite this article:

Zamergrad MV, Kunelskaya NL, Guseva AL, et al. . Betahistine in vestibular disorders: current concepts and perspectives. Russian Bulletin of Otorhinolaryngology. 2021;86(2):73‑81. (In Russ.)
https://doi.org/10.17116/otorino20218602173

Recommended articles:
Meniere’s disease and vestibular migraine: differential diagnostics and treatment. Russian Bulletin of Otorhinolaryngology. 2025;(1):57-63
Remote technologies in the mana­gement of patients with vestibular pathology. Russian Bulletin of Otorhinolaryngology. 2025;(3):53-59
Intralabyrinthine schwannoma masking as Meniere’s disease. Russian Bulletin of Otorhinolaryngology. 2025;(3):67-72

References:

  1. Neuhauser HK. The epidemiology of dizziness and vertigo. Handbook of Clinical Neurology. 2016;137:67-82.  https://doi.org/10.1016/B978-0-444-63437-5.00005-4
  2. Olsson Möller U, Midlöv P, Kristensson J, Ekdahl C, Berglund J, Jakobsson U. Prevalence and predictors of falls and dizziness in people younger and older than 80 years of age — a longitudinal cohort study. Archives of Gerontology and Geriatrics. 2013;56(1):160-168.  https://doi.org/10.1016/j.archger.2012.08.013
  3. Lilenko SV, Janov JuK, Sitnikov VP. Rasstrojstva ravnovesija. Chast’ I: Jetiopatogenez i diagnostika. SPb.: RIA-MIA; 2005. (In Russ.).
  4. Strupp M, Dlugaiczyk J, Ertl-Wagner BB, Rujescu D, Westhofen M, Dieterich M. Vestibular Disorders. Arzteblatt International. 2020;117(17):300-310.  https://doi.org/10.3238/arztebl.2020.0300
  5. Zamergrad MV, Parfenov VA, Yakhno NN, Melnikov OA, Morozova SV. The diagnosis of systemic vertigo in out-patient practice. Nevrologicheskij zhurnal. 2014;19(2):23-29. (In Russ.).
  6. Lacour M, van de Heyning PH, Novotny M, Tighilet B. Betahistine in the treatment of Ménière’s disease. Neuropsychiatric Disease and Treatment. 2007;3(4):429-440. 
  7. Ihler F, Bertlich M, Sharaf K, Strieth S, Strupp M, Canis M. Betahistine exerts a dose-dependent effect on cochlear stria vascularis blood flow in guinea pigs in vivo. PLoS One. 2012;7(6):e39086. https://doi.org/10.1371/journal.pone.0039086
  8. Laurikainen E, Miller JM, Nuttall AL, Quirk WS. The vascular mechanism of action of betahistine in the inner ear of the guinea pig. European Archives of Oto-Rhino-Laryngology. 1998;255(3):119-123.  https://doi.org/10.1007/s004050050025
  9. Barak N. Betahistine: what’s new on the agenda? Expert Opinion on Investigational Drugs. 2008;17(5):795-804.  https://doi.org/10.1517/13543784.17.5.795
  10. Pathy J, Menon G, Reynolds A, Van Strik R. Betahistine hydrochloride (Serc) in cerebrovascular disease: a placebo-controlled study. Age and Ageing. 1977;6(3):179-184.  https://doi.org/10.1093/ageing/6.3.179
  11. Valli P. Betahistine reduces the resting firing rate of vestibular receptors in the frog. Acta Oto-Laryngologica. Supplementum. 2000;544:8-10.  https://doi.org/10.1080/000164800750044416
  12. Soto E, Chávez H, Valli P, Benvenuti C, Vega R. Betahistine produces post-synaptic inhibition of the excitability of the primary afferent neurons in the vestibular endorgans. Acta Oto-Laryngologica. Supplementum. 2001;545:19-24.  https://doi.org/10.1080/000164801750388045
  13. Lacour M, Sterkers O. Histamine and betahistine in the treatment of vertigo: elucidation of mechanisms of action. CNS Drugs. 2001;15(11):853-870.  https://doi.org/10.2165/00023210-200115110-00004
  14. Botta L, Mira E, Valli S, Zucca G, Benvenuti C, Fossati A, Soto E, Guth P, Valli P. Effects of betahistine and of its metabolites on vestibular sensory organs. Acta Otorhinolaryngologica Italica. 2001;21(3 suppl 66):24-30. 
  15. Nauta JJ. Meta-analysis of clinical studies with betahistine in Ménière’s disease and vestibular vertigo. European Archives of Oto-Rhino-Laryngology. 2014;271(5):887-897.  https://doi.org/10.1007/s00405-013-2596-8
  16. Della Pepa C, Guidetti G, Eandi M. Betahistine in the treatment of vertiginous syndromes: a meta-analysis. Acta Otorhinolaryngologica Italica. 2006;26:208-215. 
  17. James AL, Burton MJ. Betahistine for Menière’s disease or syndrome. Cochrane Database of Systematic Reviews. 2001;2001(1):CD001873. https://doi.org/10.1002/14651858.CD001873
  18. Strupp M, Dieterich M, Brandt T. The treatment and natural course of peripheral and central vertigo. Deutsches Arzteblatt International. 2013;110(29-30):505-515.  https://doi.org/10.3238/arztebl.2013.0505
  19. Magnan J, Özgirgin ON, Trabalzini F, Lacour M, Escamez AL, Magnusson M, Güneri EA, Guyot JP, Nuti D, Mandalà M. European Position Statement on Diagnosis, and Treatment of Meniere’s Disease. The Journal of International Advanced Otology. 2018;14(2):317-321.  https://doi.org/10.5152/iao.2018.140818
  20. Benecke H, Pérez-Garrigues H, Bin Sidek D, Uloziene I, D K, Sondag E, Theeuwes A; OSVaLD investigators. Effects of betahistine on patient-reported outcomes in routine practice in patients with vestibular vertigo and appraisal of tolerability: experience in the OSVaLD study. The International Tinnitus Journal. 2010;16(1):14-24. 
  21. Morozova SV, Alekseeva NS, Lilenko SV, Matsnev EI, Melnikov OA. Effects and safety profile of betahistine in patients in the Russian contingent of OSVaLD, an open-label observational study in vestibular vertigo. International Journal of General Medicine. 2015;8:47‐53.  https://doi.org/10.2147/IJGM.S73842
  22. Parfenov VA, Golyk VA, Matsnev EI, Morozova SV, Melnikov OA, Antonenko LM, Sigaleva EE, Situkho MI, Asaulenko OI, Popovych VI, Zamergrad MV. Effectiveness of betahistine (48 mg/day) in patients with vestibular vertigo during routine practice: The VIRTUOSO study. PLoS ONE. 2017;12(3):e0174114. https://doi.org/10.1371/journal.pone.0174114
  23. Strupp M, Zwergal A, Feil K, Bremova T, Brandt T. Pharmacotherapy of vestibular and cerebellar disorders and downbeat nystagmus: translational and back-translational research. Annals of the New York Academy of Sciences. 2015;1343:27-36.  https://doi.org/10.1111/nyas.12774
  24. Coleman CI, Limone B, Sobieraj DM, Lee S, Roberts MS, Kaur R, Alam T. Dosing frequency and medication adherence in chronic disease. Journal of Managed Care Pharmacy: JMCP. 2012;18(7):527-539.  https://doi.org/10.18553/jmcp.2012.18.7.527
  25. Instrukciya po medicinskomu primeneniyu lekarstvennogo preparata Betaserk Long, tabletki s modificirovannym vysvobozhdeniem, pokrytye plenochnoj obolochkoj, 48 mg (Ebbott Prodakts Operejshnz EjDzhi, SHvejcariya). Registracionnyj nomer: LP-006452. Accessed March 20, 2021. (In Russ.). https://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=e9a13fa6-0d53-4aa5-9303-29a46779a51c&t=
  26. Parfenov VA, Zamergrad MV, Kazei DV, Nauta J. A study of the efficacy and safety of a new modified-release betahistine formulation in the treatment of vestibular vertigo and Meniere’s disease. Zhurnal nevrologii i psihiatrii imeni SS. Korsakova. 2020;120(12):42-48. (In Russ.). https://doi.org/10.17116/jnevro202012012142
  27. Lopez-Escamez JA, Carey J, Chung WH, Goebel JA, Magnusson M, Mandalà M, Newman-Toker DE, Strupp M, Suzuki M, Trabalzini F, Bisdorff A; Classification Committee of the Barany Society; Japan Society for Equilibrium Research; European Academy of Otology and Neurotology (EAONO); Equilibrium Committee of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS); Korean Balance Society. Diagnostic criteria for Menière’s disease. Journal of Vestibular Research. 2015;25(1):1-7.  https://doi.org/10.3233/VES-150549
  28. Basura GJ, Adams ME, Monfared A, Schwartz SR, Antonelli PJ, Burkard R, Bush ML, Bykowski J, Colandrea M, Derebery J, Kelly EA, Kerber KA, Koopman CF, Kuch AA, Marcolini E, McKinnon BJ, Ruckenstein MJ, Valenzuela CV, Vosooney A, Walsh SA, Nnacheta LC, Dhepyasuwan N, Buchanan EM. Clinical Practice Guideline: Ménière’s Disease. Otolaryngology — Head and Neck Surgery. 2020;162(2 suppl):1-55.  https://doi.org/10.1177/0194599820909438
  29. Babajkova EV, Beljakova LV, Garov EV, Guseva AL, Zagorskaja EE, Zajceva OV, Karneeva OV, Kirichenko IM, Kriukov AI, Kudeeva JaJu, Kunel’skaja NL, Levina JuV, Chugunova MA, Janjushkina EV, Mirzabekjan EV. Klinicheskie rekomendacii. Bolezn’ Men’era. Nacional’naya medicinskaya associaciya otorinolaringologov. 2016. Accessed March 20, 2021. (In Russ.). https://glav-otolar.ru/assets/images/docs/clinical-recomendations/2019/%D0%9A%D0%A018%20%D0%91%D0%BE%D0%BB%D0%B5%D0%B7%D0%BD%D1%8C%20%D0%9C%D0%B5%D0%BD%D1%8C%D0%B5%D1%80%D0%B0.pdf
  30. Schuknecht H. Meniere’s disease. Journal of the Oto-laryngological Society of Australia. 1963;1:222-223. 
  31. Merchant SN, Adams JC, Nadol JB Jr. Pathophysiology of Meniere’s syndrome: are symptoms caused by endolymphatic hydrops? Otology and Neurotology. 2005;26(1):74-81.  https://doi.org/10.1097/00129492-200501000-00013
  32. Coelho DH, Lalwani AK. Medical management of Ménière’s disease. Laryngoscope. 2008;118(6):1099-1108. https://doi.org/10.1097/MLG.0b013e31816927f0
  33. Strupp M, Hupert D, Frenzel C, Wagner J, Hahn A, Jahn K, Zingler VC, Mansmann U, Brandt T. Long-term prophylactic treatment of attacks of vertigo in Menière’s disease--comparison of a high with a low dosage of betahistine in an open trial. Acta Oto-Laryngologica. 2008;128(5):520-524.  https://doi.org/10.1080/00016480701724912
  34. Mira E, Guidetti G, Ghilardi L, Fattori B, Malannino N, Maiolino L, Mora R, Ottoboni S, Pagnini P, Leprini M, Pallestrini E, Passali D, Nuti D, Russolo M, Tirelli G, Simoncelli C, Brizi S, Vicini C, Frasconi P. Betahistine dihydrochloride in the treatment of peripheral vestibular vertigo. European Archives of Oto-Rhino-Laryngology. 2003;260(2):73-77.  https://doi.org/10.1007/s00405-002-0524-4
  35. Fraysse B, Bébéar J, Dubreuil C, Bergès C, Dauman R. Dichlorhydrate de bétahistine versus flunarizine Etude en double aveugle dans les vertiges récurrents avec ou sans syndrome typique de Ménière. Acta Oto-Laryngologica. Supplementum. 1991;111(sup490):1-10.  https://doi.org/10.3109/00016489109128292
  36. Albera R, Ciuffolotti R, Di Cicco M, De Benedittis G, Grazioli I, Melzi G, Mira E, Pallestrini E, Passali D, Serra A, Vicini C. Double-blind, Randomized, Multicenter Study Comparing the Effect of Betahistine and Flunarizine on the Dizziness Handicap in Patients with Recurrent Vestibular Vertigo. Acta Oto-Laryngologica. 2003;123(5):588-593.  https://doi.org/10.1080/00016480310001475
  37. Nevoux J, Barbara M, Dornhoffer J, Gibson W, Kitahara T, Darrouzet V. International consensus (ICON) on treatment of Ménière’s disease. European Annals of Otorhinolaryngology, Head and Neck Diseases. 2018;135(1):29-32.  https://doi.org/10.1016/j.anorl.2017.12.006
  38. Kunelskaya NL, Melnikov OA, Guseva AL, Baybakova EV. Etiology, pathophysiology and differential diagnosis of benign paroxysmal positional vertigo. Zhurnal nevrologii i psihiatrii imeni S.S. Korsakova. 2016;116(4):79‐84. (In Russ.). https://doi.org/10.17116/jnevro20161164179-84
  39. von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T, Neuhauser H. Epidemiology of benign paroxysmal positional vertigo: a population based study. Journal of Neurology, Neurosurgery, and Psychiatry. 2007;78(7):710-715.  https://doi.org/10.1136/jnnp.2006.100420
  40. Balatsouras DG, Koukoutsis G, Fassolis A, Moukos A, Apris A. Benign paroxysmal positional vertigo in the elderly: current insights. Clinical Interventions in Aging. 2018;13:2251-2266. https://doi.org/10.2147/CIA.S144134
  41. von Brevern M, Bertholon P, Brandt T, Fife T, Imai T, Nuti D, Newman-Toker D. Benign paroxysmal positional vertigo: Diagnostic criteria Consensus document of the Committee for the Classification of Vestibular Disorders of the Bárány Society. Acta Otorrinolaringologica Espanola. 2017;68(6):349-360.  https://doi.org/10.1016/j.otorri.2017.02.007
  42. Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T, Holmberg JM, Mahoney K, Hollingsworth DB, Roberts R, Seidman MD, Steiner RW, Do BT, Voelker CC, Waguespack RW, Corrigan MD. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngology — Head and Neck Surgery. 2017;156(3 suppl):1-47.  https://doi.org/10.1177/0194599816689667
  43. İnan HC, Kıraç M. An Evaluation of the Effects of Betahistine and Dimenhydrinate on Posterior Canal Benign Paroxysmal Positional Vertigo. Turkish Archives of Otorhinolaryngology. 2019;57(4):191-196.  https://doi.org/10.5152/tao.2019.4185
  44. Cavaliere M, Mottola G, Iemma M. Benign paroxysmal positional vertigo: a study of two manoeuvres with and without betahistine. Acta Otorhinolaryngologica Italica. 2005;25(2):107-112. 
  45. Sayin I, Koç RH, Temirbekov D, Gunes S, Cirak M, Yazici ZM. Betahistine add-on therapy for treatment of subjects with posterior benign paroxysmal positional vertigo: a randomized controlled trial. Brazilian Journal of Otorhinolaryngology. 2020;S1808-8694(20)30141-5.  https://doi.org/10.1016/j.bjorl.2020.07.011
  46. Jeong SH, Kim HJ, Kim JS. Vestibular neuritis. Seminars in Neurology. 2013;33(3):185-194.  https://doi.org/10.1055/s-0033-1354598
  47. Pal’chun VT, Makoeva AA, Guseva AL. Dizziness and vertigo associated with vestibular neuronitis: The approaches to the diagnostics and treatment. Vestnik otorinolaringologii. 2018;83(3):4-10. (In Russ.). https://doi.org/10.17116/otorino20188334
  48. Strupp M, Zingler VC, Arbusow V, Niklas D, Maag KP, Dieterich M, Bense S, Theil D, Jahn K, Brandt T. Methylprednisolone, valacyclovir, or the combination for vestibular neuritis. New England Journal of Medicine. 2004;351(4):354-361.  https://doi.org/10.1056/NEJMoa033280
  49. Ismail EI, Morgan AE, Abdel Rahman AM. Corticosteroids versus vestibular rehabilitation in long-term outcomes in vestibular neuritis. Journal of Vestibular Research: Equilibrium and Orientation. 2018;28(5-6):417-424.  https://doi.org/10.3233/VES-180645
  50. Tokle G, Mørkved S, Bråthen G, Goplen FK, Salvesen Ø, Arnesen H, Holmeslet B, Nordahl SHG, Wilhelmsen KT. Efficacy of Vestibular Rehabilitation Following Acute Vestibular Neuritis: A Randomized Controlled Trial. Otology and Neurotology. 2020;41(1):78-85.  https://doi.org/10.1097/MAO.0000000000002443
  51. Han BI, Song HS, Kim JS. Vestibular rehabilitation therapy: review of indications, mechanisms, and key exercises. Journal of Clinical Neurology. 2011;7(4):184-196.  https://doi.org/10.3988/jcn.2011.7.4.184
  52. Berisavac II, Pavlović AM, Trajković JJ, Šternić NM, Bumbaširević LG. Drug treatment of vertigo in neurological disorders. Neurology India. 2015;63(6):933-939.  https://doi.org/10.4103/0028-3886.170097
  53. Scholtz AW, Steindl R, Burchardi N, Bognar-Steinberg I, Baumann W. Comparison of the therapeutic efficacy of a fixed low-dose combination of cinnarizine and dimenhydrinate with betahistine in vestibular neuritis: a randomized, double-blind, non-inferiority study. Clinical Drug Investigation. 2012;32(6):387-399.  https://doi.org/10.2165/11632410-000000000-00000
  54. Lempert T, Olesen J, Furman J, Waterston J, Seemungal B, Carey J, Bisdorff A, Versino M, Evers S, Newman-Toker D. Vestibular migraine: diagnostic criteria. Journal of Vestibular Research. 2012;22(4):167-172.  https://doi.org/10.3233/VES-2012-0453
  55. Gekht AB, Vjalkova AB, Galanov DV. Clinical and neurological analysis of the effectiveness of betahistine in dizziness in patients in the recovery period of stroke. Zhurnal nevrologii i psihiatrii imeni S.S. Korsakova. 2005;15:32-38. (In Russ.).
  56. von Brevern M, Lempert T. Vestibular migraine. Handbook of Clinical Neurology. 2016;137:301-316.  https://doi.org/10.1016/B978-0-444-63437-5.00022-4
  57. von Brevern M, Zeise D, Neuhauser H, Clarke AH, Lempert T. Acute migrainous vertigo: clinical and oculographic findings. Brain. 2005;128(Pt 2):365-374.  https://doi.org/10.1093/brain/awh351
  58. Obermann M, Wurthmann S, Steinberg BS, Theysohn N, Diener HC, Naegel S. Central vestibular system modulation in vestibular migraine. Cephalalgia. 2014;34(13):1053-1061. https://doi.org/10.1177/0333102414527650
  59. Yuan H, Silberstein SD. Histamine and Migraine. Headache. 2018;58(1):184-193.  https://doi.org/10.1111/head.13164
  60. Popkirov S, Staab JP, Stone J. Persistent postural-perceptual dizziness (PPPD): A common, characteristic and treatable cause of chronic dizziness. Practical Neurology. 2018;18(1):5-13.  https://doi.org/10.1136/practneurol-2017-001809
  61. Lee JO, Lee ES, Kim JS, Lee YB, Jeong Y, Choi BS, Kim JH, Staab JP. Altered brain function in persistent postural perceptual dizziness: A study on resting state functional connectivity. Human Brain Mapping. 2018;39(8):3340-3353. https://doi.org/10.1002/hbm.24080

Email Confirmation

An email was sent to test@gmail.com with a confirmation link. Follow the link from the letter to complete the registration on the site.

Email Confirmation

We use cооkies to improve the performance of the site. By staying on our site, you agree to the terms of use of cооkies. To view our Privacy and Cookie Policy, please. click here.