Non sedating antihistamine comparison
Betahistine can also be easily obtained through US compounding pharmacies, with a prescription.
It is difficult to see why an inert substance must be prescribed, but nevertheless, this is the situation in the US.
Nevertheless, these studies may have been flawed and a review suggested that it is presently still unclear if betahistine has any effect in Meniere's disease (James and Burton, 2001).
Another Cochrane study from 2016 (Murdin et al), suggested that "Low quality evidence suggests that in patients suffering from vertigo from different causes there may be a positive effect of betahistine in terms of reduction in vertigo symptoms.".A recent exception is the study of Motamed et al (2017) where betahistine was found superior to promethazine.Betahistine was again reviewed by the FDA in June of 1999 (click here for details).Smith reported that 94% of the ENT surgeons in the United Kingdom prescribe betahistine to their Meniere's patients (Smith et al, 2005) This drug (brand name Serc, chemical name betahistine), is advocated as a vestibular suppressant mainly for Meniere's disease.Curiously, Serc was approved by the US FDA about 50 years ago for roughly 5 years, but later approval was withdrawn because lack of evidence for efficacy and because the major report of effectiveness contained deficiencies and misrepresentations (Sampson, 2003).Our clinical judgement is that betahistine does have positive effects on vertigo, but that it is very hard to determine how great these effects are due to the immense number of poor studies and biased reviews concerning betahistine's efficacy.A recent study by Strupp (2018) suggested that betahistine could be productively combined with seligiline (an MAO inhibitor) in very low doses.A study of hydrops found that betahistine had no effect (Gurkov et al, 2012).Rosenbaum and winter concluded that based on 12 trials, betahistine might be helpful, but the "certainty of evidence is low".One would also wonder if this combination might allow one to get the (sometimes) positive effect of betahistine to reduce weight.At the time of this update (2018), we generally just send patient to a local compounding pharmacy.