Betahistine for Menière's disease

Betahistine, a histamine H1 agonist and H3 antagonist, has been used for the pharmacotherapy of Menière's disease for many decades. Earlier its mode of action and efficacy, in particular in low dosages, were the subject of controversy mainly because valid experimental or clinical data were not available. Recent animal studies, however, showed that betahistine increases cochlear blood flow in a sigmoid dose-dependent way, thus supporting the hypothesis that it may act by improving cochlear microcirculation. In terms of its clinical efficacy, two studies demonstrated that a high-dose (at least 48 mg t.i.d.) and long-term treatment (at least six to 12 months) have a significant prophylactic effect on the occurrence of attacks in Menière's disease.