How Long Should I Take Betahistine For Vertigo

Your doctor may advise you to try betahistine for 6 to 12 months to see if it helps to reduce your symptoms. If it does, it can then be continued.

How long does betahistine take to stop vertigo?

Key facts –

You’ll usually take betahistine 3 times a day, leaving 6 to 8 hours between doses.When you start taking betahistine it may take a couple of weeks before you notice any improvements.Common side effects include headache, feeling sick or indigestion. They’re usually mild and do not last long.It’s best to take your tablets with or after food. This way it’s less likely to upset your stomach.

Page last reviewed: 24 August 2022 Next review due: 24 August 2025

Can betahistine be taken long term?

How does betahistine work? When you have Ménière’s disease, your symptoms such as feeling dizzy, a spinning sensation, hearing loss and ringing in the ears are probably caused by a build-up of fluid in the inner ear. Betahistine is thought to work by increasing blood flow to this part of your ear and reducing the amount of fluid there.

1. This helps to reduce the number of attacks you have and to make them milder.
2. How long does it take to work? When you start taking betahistine, it may take a couple of weeks before you notice any improvements.
3. Even when you start feeling better, your doctor may want you to carry on taking the tablets for some time, to stop your symptoms from coming back.

Are there any long-term side effects? Betahistine is unlikely to do you any harm, even if you take it for a long time. It’s generally a very safe medicine. Are there any other medicines to help with my symptoms of Ménière’s disease? Your doctor may prescribe a short course of prochlorperazine, or a drowsy antihistamine, to help if you’re feeling dizzy or being sick (vomiting).

1. Prochlorperazine helps relieve severe nausea and vomiting.
2. This medicine can make you feel sleepy.
3. Cinnarizine and cyclizine are types of drowsy (sedating) antihistamines.
4. Drowsy antihistamines can help if you are feeling a little sick (mild nausea), being sick, or have vertigo,
5. It’s important to take these medicines at the first sign of any symptoms.

You may need to try a few different medicines to find out what works best for you. Is betahistine different to antihistamines? Yes, it is. Betahistine is a type of medicine called a histamine analogue. It works by increasing the effect of a natural substance called histamine in your inner ear.

1. Antihistamines work by stopping histamine affecting the cells in your body.
2. They’re often used to relieve symptoms of allergies, such as hay fever, hives, conjunctivitis and reactions to insect bites or stings.
3. They can sometimes be used to prevent travel sickness and as a short-term treatment if you have trouble sleeping.

Will it affect my contraception? Betahistine does not affect any type of contraception, including the combined pill and emergency contraception, Can I drive or ride a bike while taking betahistine? Betahistine is not likely to affect your ability to drive or ride a bike.

However, do not drive or cycle if you feel dizzy or if you feel an attack of vertigo coming on. It’s important to tell the Driver and Vehicle Licensing Agency (DVLA) if you often get sudden attacks of vertigo without any warning signs. It’s likely that you’ll have to stop driving until your symptoms are under control.

Can I drink alcohol while taking betahistine? Yes, you can drink alcohol while taking betahistine. However, some people say that their Ménière’s disease symptoms improve when they stop drinking alcohol. Is there any food or drink I need to avoid? You can eat and drink normally while taking betahistine.

However, some people say their Ménière’s disease symptoms improve by eating a low-salt diet and avoiding caffeine (found in chocolate and drinks like tea, coffee, cola and energy drinks). Will recreational drugs affect it? Recreational drugs are unlikely to affect betahistine. However, taking some recreational drugs may make your symptoms worse when you have Ménière’s disease.

You can find out more about the side effects of recreational drugs on the Frank website, Page last reviewed: 24 August 2022 Next review due: 24 August 2025

Does betahistine stop vertigo?

Introduction – Vertigo and dizziness are among the most frequent symptoms in medical practice, with a lifetime prevalence of 17.0–30.0% and annual prevalence of 16.7–27.0% reported in the general population. In a study of 2064 working-age people in the community, results from a survey showed that over 20% ( n = 480) of respondents had suffered from dizziness in the previous month and 30% of these respondents had dizziness that lasted more than 5 years, Vertigo and dizziness are associated with a lower health-related quality of life and a negative impact upon daily living, Vestibular vertigo is characterised by illusion of movement and spatial orientation, It can be further classified as central or peripheral, depending on whether the vertigo is caused by lesions of the central or peripheral parts of the vestibular system, Vestibular vertigo affects 1.8–4.9% of adults every year, is estimated to affect 3.0–10.0% of adults in their lifetime and is associated with a significantly ( p ≤ 0.001) higher occurrence of medical consultation, sick leave, interruption of daily activities, and avoidance of leaving the house compared with non-vestibular dizziness, Risk factors associated with vestibular vertigo include female sex, depression, hypertension and dyslipidaemia, Peripheral vestibular disorders causing vertigo include Ménière’s disease, benign paroxysmal positional vertigo and vestibular neuronitis, Medical treatments administered for vestibular vertigo vary depending on aetiology; for Ménière’s disease, medical treatment options include salt restriction, diuretics, betahistine, and intratympanic injection of corticosteroids or gentamicin, Betahistine is approved in >115 countries for the treatment of Ménière’s disease and the symptoms of vertigo. It is a structural analogue of histamine, and a weak agonist for histamine H(1) receptors and an antagonist for H(3) receptors, It has been found to improve vestibular compensation in animal models of unilateral vestibular dysfunction, by increasing vestibulocochlear blood flow and reducing the histamine-induced excitatory response in vestibular cells by blocking local H(3) autoreceptors, Several clinical trials have demonstrated that betahistine is effective in reducing the frequency and severity of vertigo, and improving vertigo-associated symptoms, including nausea and vomiting, A 2016 Cochrane Review of randomised controlled trials of betahistine versus placebo in patients with symptoms of vertigo suggested that betahistine may have a positive effect in terms of reduction in vertigo symptoms; however, it was noted that the quality of available evidence is low, Continued improvements in vertigo have been observed throughout betahistine treatment, and at a range of doses, for periods lasting from 45 days up to 12 months ; therefore, a longer duration of betahistine treatment may be required for the maximal effect of betahistine to be observed. Patient and investigator opinions of betahistine treatment have been high in these studies, suggesting that the effects of betahistine on vertigo symptoms may translate to reductions in the disease burden of vertigo. While betahistine has been a key part of the armamentarium for treating vertigo in general clinical practice for many years, the results of the recent Cochrane review highlight that more evidence is required to understand the size of any treatment benefit in terms of its ability to facilitate vestibular compensation, Moreover, a greater understanding is needed of the extent to which this effect is maintained after treatment cessation. The VIRTUOSO study was a multicentre, post-marketing observational programme in Russia and Ukraine that investigated the effectiveness of betahistine dihydrochloride (Betaserc ® ; Abbott Laboratories) when administered at the maximal recommended dose of 48 mg/day. It also aimed to assess the course of vestibular vertigo after discontinuation of betahistine treatment in routine clinical settings.

When is the best time for betahistine?

Take the tablet with or after a meal. However, Betahistine can cause mild stomach problems (listed in Section 4). Taking Betahistine with food can help reduce stomach problems. Always follow your doctor’s instructions because your doctor might adjust your dose.

How many days can I take betahistine?

How long to take it for. You may need to take betahistine for a long time, such as several months or years, to prevent the symptoms of Ménière’s disease.

Can I take betahistine everyday?

Betahistine information. Betahistine side effects

Betahistine is used to ease the symptoms of Ménière’s disease.The usual dose is one tablet three times daily.Where possible, take the tablets with something to eat.

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Type of medicine A histamine analogue Used for Ménière’s disease symptoms in adults Also called Serc® Available as Tablets

is a condition of the inner ear. It typically causes attacks of dizziness with a spinning sensation (vertigo), hearing loss and noises in the ear (tinnitus). The attacks can vary in severity, and in how often they occur. It is thought that a build-up of fluid in the inner ear causes the symptoms.

Treatment can help to ease and prevent symptoms. Betahistine is thought to work by increasing the blood flow around the inner ear. This reduces the amount of fluid in the inner ear and prevents symptoms from developing. Some medicines are not suitable for people with certain conditions, and sometimes a medicine can only be used if extra care is taken.

For these reasons, before you start taking betahistine it is important that your doctor knows:

If you are pregnant or breastfeeding.If you have ever had a stomach ulcer.If you have asthma.If you have a tumour on your adrenal gland, called phaeochromocytoma.If you are taking any other medicines. This includes any medicines which are available to buy without a prescription, as well as herbal and complementary medicines.If you have ever had an allergic reaction to a medicine.

Before you start the treatment, read the manufacturer’s printed information leaflet from inside the pack. It will give you more information about betahistine, and will also provide you with a full list of the side-effects which you could experience from taking it.Take betahistine exactly as your doctor tells you to. It is usual to take one 16 mg tablet three times a day at first. Once your symptoms are under control, your doctor may then reduce your dose to one 8 mg tablet three times a day. You will find the directions for taking the tablets on the label of the pack to remind you about what the doctor said to you. Where possible, take betahistine tablets with something to eat, such as a snack or straight after a meal.Swallow the tablet with a drink of water. Try to take your doses at the same times of day each day, as this will help you to remember to take the tablets regularly.If you forget to take a dose, do not worry, just remember to take the next dose when it is due. Do not take two doses together to make up for a forgotten dose.

If you are a driver, you must stop driving when Ménière’s disease is diagnosed. This is because you may have sudden attacks of a spinning sensation (vertigo) with little warning. The Driver and Vehicle Licensing Agency (DVLA) will allow driving again when your symptoms are well controlled. Taking betahistine will not affect your ability to drive.If you take betahistine every day it is unlikely to stop all attacks, but it may reduce the number and/or the severity of your attacks. Your doctor may advise a trial of betahistine for 6-12 months to see if it helps to reduce your symptoms. If it does, it can then be continued.Some people with Ménière’s disease claim their symptoms improve with a low-salt diet, regular exercise, stopping smoking, and cutting out caffeine and alcohol. Although there is little evidence to prove that diet and lifestyle can help, these may be worth trying.If you buy any medicines, check with a pharmacist that they are suitable to take with betahistine. Betahistine may not be as effective if it is taken alongside a medicine containing an antihistamine.

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with betahistine. You will find a full list in the manufacturer’s information leaflet supplied with your medicine.

Common betahistine side-effects (these affect fewer than 1 in 10 people)	What can I do if I experience this?
Feeling sick (nausea), indigestion	Remember to take your doses of betahistine with food
Headache	Drink plenty of water and ask your pharmacist to recommend a suitable painkiller. If the headaches continue, let your doctor know
Less common side-effects	What can I do if I experience this?
Tummy (abdominal) bloating or discomfort	Taking the tablets with food helps to reduce these side-effects. If they continue or become troublesome, speak with your doctor
Allergic skin reactions such as itching and rash	Use a moisturiser to soothe your skin. If the rash continues or is severe, contact your doctor for advice

If you experience any other symptoms which you think may be due to the tablets, speak with your doctor or pharmacist for further advice.

Keep all medicines out of the reach and sight of children.Store in a cool, dry place, away from direct heat and light.

Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty. This medicine is for you. Never give it to other people even if their condition appears to be the same as yours. If you are having an operation or dental treatment, tell the person carrying out the treatment which medicines you are taking. Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you. If you have any questions about this medicine ask your pharmacist.

Betahistine information. Betahistine side effects

Why is betahistine banned in the US?

Is betahistine approved in the U.S.? – Betahistine is not approved in the United States. Interestingly, it was approved in the U.S. in the 1960s but after 5 years the approval was withdrawn due to a lack of evidence for its efficacy. Further studies have also had design flaws, such as the lack of a control group or the comparison group being prescribed a homeopathic preparation, except for a study in 2017 (Motamed et al) that reported betahistine was superior to promethazine.

How long does it take for ear crystals to dissolve?

Can ear crystals move back to where they belong on their own? – Over time, ear crystals may dissolve, but bear in mind that this could take weeks or longer, and during that time, a person would have to endure the extreme discomfort of BPPV, where even the slightest head movements would throw their world into disarray.

Does betahistine help balance problems?

Abstract – In balance system assessment there is no single set of tests applicable for all patients. A comprehensive medical history plays a main role in balance assessment. Patients often describe the same disorders in different ways. The aim of our work was to analyze effectiveness of betahistine hydrochloride (Betaserc) treatment on vertigo, nausea, vomiting, tinnitus and progressive hearing loss basing on the medical assessment (interview) performed by doctors and patient’s personal questionnaires as well as to collect and accumulate data about balance system disorders.

1. We prepared questionnaires for both doctors and patients.
2. The doctor’s questionnaire was divided into three sections.
3. In the first section we included questions about direct cause of visit at the doctor’s office.
4. Questions were covering problems regarding balance system disorders (difficulty to keep erect position), vertigo, tinnitus, hearing impairment and other problems.

The second section of the questionnaire included assessment of treatment effectiveness through the first 14 days and on the 28th day (a control visit). A third section of the questionnaire was focused on estimation of intensity of balance system disturbances.

Patient’s questionnaire included everyday self observations of intensity of disturbances within the 14 days observation period. We analyzed data of 980 patients, of the age between 16 and 96 years (mean age-54.1). There were 57.8% females and 42.2% males. From the group of 980 patients we separated a group of patients under 40 and over 60 years of age for additional analysis.

Having analyzed doctors questionnaires we noted that the most frequent cause of patients’ visits were: vertigo-in 770 people (78.57%), tinnitus-in 708 people (72.24%), disturbance of balance system-in 612 people (62.45%), hearing loss-in 607 people (61.94%) and other problems-in 72 people (7.35%).

• Patients over 60 years of age described vertigo as rolling and falling (38.92%).
• Patients under 40 years of age described vertigo as a body rotation and they were able to indicate direction of rotating movement (53.78%) in this group balance disturbances were intensified by moving of the head (56.49%).

Both doctors and patients noticed higher percentage of answers “none” and “minimal difficulty in everyday life” on 14th and 28th day of observation in all analyzed groups, especially in people under 40 years of age. Properly prepared questionnaire for doctors and patients is very helpful not only at initial interview but also at reviewing the current condition of patient as well as at monitoring effects of treatment.

1. Aliments and symptoms self noticed by patients are more serious and troublesome than those noticed by doctors.
2. Ailments linked to disturbances of balance system noticed by group of patients under 40 years of age are usually sudden and shorter in duration and more intensive than in group of patients over 60 years of age.

Betaserc used in treatment of balance system disorders lessens the insensitivity of vertigo, gait disturbances and nausea/vomiting. It does not affect hearing loss or tinnitus. The first therapeutic goals are achieved (especially in patients under 40 years of age) after 14 days of treatment.

What brain problems cause vertigo?

Central vertigo is due to a problem in the brain, usually in the brain stem or the back part of the brain (cerebellum). Central vertigo may be caused by: Blood vessel disease. Certain drugs, such as anticonvulsants, aspirin, and alcohol.

Does betahistine reduce anxiety?

Anxiety symptoms – As shown in Figure 5, the average HARS scores decreased over time in both groups. After 4-week treatment, the average HARS scores decreased from 11.34±2.52 to 5.46±2.14 in the high-dose group and from 11.14±3.39 to 4.38±2.55 in the low-dose group. The repeated-measures ANOVA showed a significant effect of time ( P <0.00001), indicating that both high-dose and low-dose betahistine could significantly reduce the HARS score. Meanwhile, the repeated-measures ANOVA showed a significant effect of group × time interaction ( P =0.03), indicating the significantly different reductions between the two groups. The average HARS scores were similar at baseline ( P =0.73) and week 1 ( P =0.77), but were significantly different at week 2 ( P =0.03) and week 4 ( P =0.02) between the two groups. Average HARS scores at baseline and at weeks 1, 2, and 4 in both groups. Abbreviation: HARS, Hamilton Anxiety Rating Scale.

Does betahistine affect blood pressure?

Increases in vestibular blood flow and decreases in blood pressure were observed in response to betahistine infusions.

Is betahistine strong?

Introduction – Meniere’s disease is characterised by recurrent attacks of vertigo, fluctuating sensorineural hearing loss, aural fullness, and tinnitus.1 Its histopathological hallmark is endolymphatic hydrops.2 3 Lifetime prevalence of the disease in the United States is reported as 190 per 100 000 people, with a ratio of 1.89 women to every man.4 5 Annual incidence of the disease in the USA was 15.3 per 100 000 people (age adjusted rate).6 The peak age of onset is during the fifth and sixth decade.7 For patients with Meniere’s disease, unpredictable vertigo attacks are the most important and unpleasant symptom.

1. Although the disease is clinically problematic and the target of several treatments, there are so far no validated instruments related to vertigo that are based on patient reported outcomes (PRO) for comprehensively evaluating disease severity in a clinical trial.
2. Treatment should aim to stop or reduce the number and severity of acute attacks of vertigo, reduce or eliminate tinnitus, and prevent impaired vestibular function and hearing loss.

Given the chronic nature of the disease and the fluctuating and episodic pattern of symptoms, the long term effectiveness of any prophylactic drug should be investigated. Many therapeutic approaches to Meniere’s disease have been studied. These include a low salt diet and diuretics, 8 intratympanic steroid application, 9 10 or minimal invasive interventions (such as insertion of a ventilation tube into the tympanic membrane, 11 12 endolymphatic sac surgery, 13 or pulsed low pressure delivery (using Meniett devices)).14 15 16 17 For patients who do not respond to these treatments, more aggressive procedures can be considered, such as intratympanic application of gentamycin, 18 19 plugging of the semicircular canal, labyrinthectomy, or neurectomy.20 21 22 23 However, these interventions are irreversible and could damage the cochlear and vestibular organ; furthermore, a recent Cochrane review could not show any evidence of benefit in a surgical approach.24 25 Betahistine is a licensed drug for Meniere’s disease-like symptom complexes, which contains the active ingredient betahistine dihydrochloride (maximum daily dose 48 mg) or betahistine dimesylate (maximum daily dose 36 mg).

1. Betahistine is a strong H3 antagonist and a weak H1 agonist 26 with three sites of action.
2. Firstly, it increases dose-dependent cochlear blood flow, 27 mainly via the H3 receptor as an inverse agonist.28 Because betahistine has a strong first pass effect and is metabolised in the liver into three metabolites, not only betahistine but also its major metabolite aminoethylpyridine increases cochlear blood flow.29 Secondly, betahistine increases histamine turnover in the central nervous and vestibular system, also mainly via the H3 receptor.

Thirdly, it decreases vestibular input in the peripheral vestibular system, with possible involvement with the H3 and H4 receptors. How betahistine might have an effect in the prophylactic treatment of Meniere’s disease is so far unknown. It could lead to an improvement of labyrinthine microcirculation, thereby rebalancing the production and resorption of endolymph.

1. The drug was first registered in Europe in the 1970s and has been administered to more than 100 million patients so far.
2. In Germany, betahistine is the first line treatment for Meniere’s disease in clinical practice, before consideration of endolymphatic sac surgery or ablative gentamicin treatment.30 The drug is inexpensive and well tolerated, and is one of the most frequently prescribed drugs for Meniere’s disease in Europe.31 32 In the USA, betahistine is not approved by the Food and Drug Administration but can be easily obtained through US compounding pharmacies with a prescription.

Several clinical studies assessing the effect of betahistine on the vestibular system and, to a lesser degree, audiological symptoms suggested that the drug improved these symptoms.33 34 According to a Cochrane systematic review of betahistine for Meniere’s disease or syndrome, there is, however, insufficient evidence to indicate whether betahistine has any effect.33 So far, randomised controlled trials that meet high quality standards are lacking, either due to inadequate diagnostic criteria or methods, 35 or because the effect of betahistine treatment on vertigo was assessed inadequately.

• • Predominance of trials investigating short term effects (treatment periods of six months or less)
• • Inclusion criteria of enrolled patients (for instance, no differentiation between patients with the disease and patients with other causes of vertigo)
• • High dropout rates 35 with potential for considerable attrition bias
• • Small trials or few placebo controlled trials 36
• • Varying quality of outcome measures for assessing efficacy (including quality of life scores, functional impairment, disability, and the number and severity of acute attacks of vertigo).33

The dose of betahistine in these studies varied between 16 and 72 mg per day, which might explain the differences in symptom relief observed. Even higher doses of up to 480 mg per day have shown benefit for severe cases in a small case series, suggesting a possible effect of high dose regimens in the treatment of Meniere’s disease.37 The drug seems to retain a good tolerability profile.

1. On the basis of many years’ clinical experience, the dose was successively increased to 48 mg three times a day, pointing towards the role of long term treatment (up to 12 months).
2. This dose increase was supported by an open, uncontrolled, non-masked study without a placebo arm that compared a high dose regimen of 48 mg three times daily with the recommended standard dose of 16 or 24 mg three times daily.36 This non-interventional study showed that the higher dose was superior to the lower dose, and that the treatment effect of betahistine on the incidence of attacks of vertigo became more prominent over time.

Owing to variable methodological rigour and shortcomings in previous trials including the potential risk of bias, the medical treatment of Meniere’s disease with betahistine (BEMED) trial was designed. This investigator initiated, prospective, longitudinal, multicentre, double blind, randomised, placebo controlled, three arm, parallel group, phase III superiority trial aimed to assess the long term prophylactic effects of betahistine dihydrochloride in two different doses and placebo.

The doses and placebo were administered continuously for nine months, and investigators observed their effect on the frequency, duration, and severity of acute attacks caused by Meniere’s disease, vertigo related impairment of quality of life, and vestibular and audiological function. The trial also aimed to ascertain the speed of effect—that is, whether the two active doses can be distinguished from each other or from placebo by how quickly reduction in attack frequency is achieved.38 Additionally, the tolerance and adverse events were examined.

We report the prespecified efficacy and safety analyses at nine months for the BEMED trial.

What is the best medication for vertigo?

What are the treatment options for vertigo? – The specific diagnosis dictates which of these treatment options is the best for each patient:

Migraine-related vertigo typically responds to medications that can prevent migraines.

Acute vertigo is best treated with nonspecific medication such as dimenhydrinate (Dramamine®) and meclizine (Bonine®). These medications are eventually weaned as they can prevent healing over the long-term, explains Dr. Fahey.

Vertigo that only occurs within the first five minutes of standing is typically due to blood pressure dropping (orthostatic hypotension). There are medications that can be used in this situation including (Dramamine®) and meclizine (Bonine®). Patients can also wear thigh-high compression stockings or abdominal binders, or raise the head of the bed, increase salt intake and increase fluids.

Intermittent vertigo provoked by movement of the head or neck typically responds to a special type of physical therapy called vestibular rehabilitation,

Intermittent vertigo provoked by very specific movements such as lying down in bed or rolling over in bed may be Benign Paroxysmal Positional Vertigo – which typically responds very well to a specific sequence of movements known as the Epley maneuver. “These movements can be found online but I always think it best to have them performed by a professional.”

Does betahistine cause weight gain?

Discussion – This study was designed to test the comparative efficacy of metformin and betahistine on preventing further weight gain or causing weight decrease in people with schizophrenia or bipolar disorder who had gained more than 10% weight in the first 3 years of treatment with antipsychotics.

• To our knowledge, this is the first research to compare metformin and betahistine in treating antipsychotic-induced weight gain.
• After a 12-week trial, we found that betahistine treatment effectively controlled antipsychotic-induced weight gain, while metformin significantly relieved antipsychotic-induced weight gain.

Both metformin and betahistine were found to have a significant advantage when compared with placebo. Current interventions to minimize antipsychotic-induced weight gain and metabolic syndrome include pharmacologic and non-pharmacologic ways ( 26 ). Pharmacologic interventions include switching to another antipsychotic, which has less weight gain effect, or adding an adjuvant.

• However, individuals who switched antipsychotics had significantly shorter times until discontinuation compared with individuals who continued with their baseline medication ( 27 ).
• Therefore, the risk of relapse should be carefully considered before medication switching ( 28 ).
• Meanwhile, non-pharmacological interventions usually consist of lifestyle intervention and cognitive behavior strategies ( 29 ).

However, there is a significant heterogeneity in non-pharmacological interventions, and the majority of these interventions are associated with poor compliance. So, adding an adjuvant should be a chance to improve antipsychotic-induced weight gain and insulin resistance.

The potential clinical effect of betahistine on reducing antipsychotic-induced weight gain and its mechanism has gained more attention in recent years. The histamine system has played a crucial role in the regulation of energy homeostasis ( 18, 30, 31 ). Specifically, H1R antagonism has been recognized as the main mechanism for predicting weight gain induced by second-generation antipsychotics (SGAs) ( 18, 32, 33 ).

Betahistine, as a H1R and H3R antagonist, can cross the blood-brain barrier, and it acts centrally by enhancing histamine neurotransmission in the hypothalamus ( 34 ). A previous animal study has suggested that co-treatment of betahistine could partially reverse olanzapine-induced body weight gain ( 19 ) and hypothalamic H1R pathway change ( 20 ).

1. The clinical application of betahistine against weight gain has thus been the focus.
2. In a multicenter randomized controlled trial (RCT) study of healthy women, Barak et al.
3. 35 ) reported that in over 12 weeks of treatment with betahistine, there was a significant weight loss ( 35 ).
4. Later, in 2016, their study showed that the coadministration of betahistine and olanzapine mitigated the weight gain induced by olanzapine in healthy women ( 21 ).

In patients diagnosed with schizophrenia, Poyurovsky et al. ( 36 ) held a study for 6 weeks with the coadministration of betahistine and olanzapine, which demonstrated a increase in weight during the initial 2 weeks of the trial with no additional weight gain or minor reduction of body weight for the rest of the trial, and none of the patients gained 7% of the initial body weight ( 36 ).

Another study by Poyurovsky et al. ( 37 ) showed that the reboxetine-betahistine combination produced a significant attenuation of olanzapine-induced weight gain ( 37 ), and the weight attenuating effect of this combination was two-fold higher than reboxetine alone ( 38 ). Another study carried out on female obese women demonstrated the beneficial effect of betahistine on improving dyslipidemia ( 39 ).

However, a 1-day administration of betahistine in healthy women showed no difference in energy intake ( 40 ). Our research was inconsistent with most of the previous studies and for the first time showed that the treatment of betahistine could mitigate the increased insulin level and IRI induced by antipsychotics.

• Metformin mainly increases the function of insulin in the liver and decreases the rate of hepatic glucose production ( 41 ).
• Metformin is regarded as the first line treatment for type 2 diabetes mellitus ( 42 ); besides, it was also used in non-diabetics against obesity.
• In the hypothalamus, metformin increases STAT3 signaling while it decreases NPY and AgRP expression, which suggests that metformin mediated food intake by affecting multiple appetite regulatory pathways ( 43, 44 ).

Metformin also improves leptin sensitivity, which is an important adipocyte-derived hormone that regulates energy balance ( 45 ). Other researchers suggested that metformin could increase the secretion of GLP-1, a satiation signal secreted by the gut ( 46 ).

In our previous study, it was found that lifestyle intervention and metformin alone and in combination were effective for reversing antipsychotic-induced weight gain, while metformin alone was more effective for inducing weight loss and improving insulin sensitivity than lifestyle intervention alone, and metformin remained effective and safe in attenuating olanzapine-induced weight gain and insulin resistance in drug naïve first episode patients ( 15 ).

As a follow-up to our initial study, we found that the addition of metformin to antipsychotics was a potential treatment for dyslipidemia in people with schizophrenia ( 13 ) and amenorrhea in females with schizophrenia ( 14, 47 ). Multiple compounds have been investigated as add-on medications to cause weight loss, and metformin has the best evidence ( 26 ).

However, in 2018, a meta-analysis that included six RCTs found that combining metformin and lifestyle interventions shows significant reduction in weight and BMI compared with metformin alone ( 48 ). Three metformin meta-analyses confirmed the significant effect of metformin in reducing BMI and improving insulin sensitivity ( 49 – 51 ).

Our findings were consistent with most of these studies and meta-analyses. In addition, our study showed that metformin significantly decreased body weight, BMI, fasting glucose level, insulin level, and IRI but not waist circumference when compared with betahistine.

These findings suggested that the treatment with metformin could be more efficacious than betahistine in preventing and reversing the weight gain induced by antipsychotic agents in people with schizophrenia or bipolar disorder, while both treatments were found to have a significant advantage over placebo.

Few studies had compared the effect of betahistine and metformin before. According to our study, although betahistine group failed to decrease the body weight significantly, it prevented further weight gain with a decreasing tendency. Therefore, we suggest metformin as the first consideration for antipsychotic-induced weight gain while betahistine as an alternative if metformin was not tolerated or adhered.

This study has some limitations. First, the data were collected from two independent studies, thus, the sample error was inevitable and STUDY 2 was not a randomized placebo controlled clinical trial. Second, this study was based on schizophrenia or bipolar disorder participants with four different antipsychotics: clozapine, olanzapine, risperidone, or quetiapine.

Previous studies suggested that the type of antipsychotics affects the plasma adiponectin level and also affects body weight significantly ( 52, 53 ). However, we were unable to assess this effect by the type of antipsychotics because of the small sample size in our study.

Third, we failed to test leptin level though it has been proven to play an important role in weight gain ( 54 ). Finally, the participants were followed up for 12 weeks only, so we still cannot predict the long-term effects of metformin and betahistine. Further research including the well-designed RCT test to testify the findings or genetic variations, which might provide some explanation on individualized treatment response, should be carried out.

In conclusion, despite these limitations, this study has clearly shown that metformin could be more efficacious than betahistine in increasing insulin sensitivity and reversing the weight gain induced by antipsychotics with 12 weeks of treatment, while both could significantly improve the body weight and insulin sensitivity induced by antipsychotics.

How many times should I take betahistine 24mg?

How should I use this medication? – The usual recommended dose of betahistine for adults is 24 mg to 48 mg given in 2 or 3 divided doses (i.e., 12 mg to 24 mg twice a day, or 8 mg to 16 mg three times a day). To prevent stomach upset, it is recommended that this medication be taken with food.

• Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications.
• If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Does betahistine cause insomnia?

Are there any side effects? – Tell your doctor or pharmacist as soon as possible if you do not feel well while you are taking SERC. All medicines can have side effects. If you do experience any side effects, most of them are minor and temporary. However, some side effects may need medical attention.

Can you take betahistine and antihistamine together?

Incompatibilities ? – Little has been published about betahistine being incompatible with anything. If one believes in the histamine agonism mechanism, it would make little sense to take a centrally acting antihistamine medication with betahistine as the betahistine might not work.

• This covers a lot of ground including many conventional “dizziness” drugs.
• Still, if there is a balance between these drugs, one might nevertheless end up better with respect to vertigo.
• A person on betahistine should be able to take purely “peripheral” acting antihistamines (such as Claratin, Allegra and Zyrtec).

Similarly a person on betahistine should not take antidepressants with central antihistamine side effects such as the “tryptylines”. This includes Elavil and Pamelor. Practically, we have not noted any interaction problems.

What is the time of action for betahistine?

Pharmacokinetics – Betahistine comes in both a tablet form as well as an oral solution, and is taken orally. It is rapidly and completely absorbed. The mean plasma elimination half-life is 3 to 4 hours, and excretion is virtually complete in the urine within 24 hours.

Why does vertigo take so long to go away?

Benign paroxysmal positional vertigo (BPPV) – Like vestibular neuronitis, benign paroxysmal positional vertigo (BPPV) often clears up without treatment after several weeks or months. It’s thought that the small fragments of debris in the ear canal that cause vertigo either dissolve or become lodged in a place where they no longer cause symptoms.

get out of bed slowly avoid activities that involve looking upwards, such as painting and decorating or looking for something on a high shelf

BPPV can be treated using a procedure called the Epley manoeuvre.

How long does it take for vertigo medicine to take effect?

4. Bottom Line – Meclizine may be used to treat vertigo or nausea and vomiting associated with motion sickness; however, it takes approximately an hour to start working and may cause drowsiness, although it is less likely than some other antihistamines to cause drowsiness.

Can I take betahistine twice a day?

How should I use this medication? – The usual recommended dose of betahistine for adults is 24 mg to 48 mg given in 2 or 3 divided doses (i.e., 12 mg to 24 mg twice a day, or 8 mg to 16 mg three times a day). To prevent stomach upset, it is recommended that this medication be taken with food.

• Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications.
• If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.