Meniere's disease: combined pharmacotherapy with betahistine and the MAO-B inhibitor selegiline-an observational study.

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Strupp M, Kraus L, Schautzer F, Rujescu D

Meniere's disease: combined pharmacotherapy with betahistine and the MAO-B inhibitor selegiline-an observational study.

J Neurol. 2018 Mar 12. pii: 10.1007/s00415-018-8809-8. doi: 10.1007/s00415-018-8809-8.

PubMed ID

29532287 [ View in PubMed

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Abstract

OBJECTIVES: Since oral betahistine has a very high first-pass effect (ca. 99%), metabolized by monoamine oxidases (MAO), the benefits of a high-dosage betahistine monotherapy were compared with those of a lower dosage of betahistine in combination with the MAO-B inhibitor (MAO-B) selegiline on the frequency of acute attacks of vertigo in patients with Meniere's disease (MD). METHODS: Thirteen adults aged 40-75 years (mean 58.9 years; six females) had initially been treated with a high dosage of betahistine dihydrochloride for at least 1 year. Under this therapy, all of them had /= 3 months prior to the combination pharmacotherapy. Subsequently, they received 5 mg/day selegiline and the dosage of betahistine was reduced to about one tenth and then individually adjusted to the dosage needed to achieve the same treatment response (/= 3 months was 3-36 24-mg tablets (mean 8.5), i.e., 72-864 mg/day [mean 204.9 mg/day, p < 0.001 (paired t test)]. One patient transiently stopped the treatment with selegiline, another one reduced the dosage to 2.5 mg/day and the attacks re-occurred after 2-4 weeks. Six out of 13 patients reported transient fullness of the head during the combined treatment; in 2 of them this went away when they switched to 2.5 mg bid. In the longer term (> 9 months), one patient had to increase the selegiline dosage to 5 mg bd, one patient stopped the treatment with selegiline. CONCLUSIONS: The achievement of the same clinical effect with a significantly lower (about 1/5) dosage of betahistine can be explained by the inhibition of the MAO-B by selegiline leading to higher serum concentrations of betahistine. This approach is in line with recent developments to bypass the first-pass effect of betahistine by transbuccal or intranasal application. Despite the substantial methodological limitations of such an observational study, this combined pharmacotherapy could be an alternative to a high-dosage monotherapy with betahistine of MD.

DrugBank Data that Cites this Article

Drugs

Betahistine

Drug Interactions

Drugs	Interaction
Integrate drug-drug interactions in your software
Betahistine Linezolid	The metabolism of Betahistine can be decreased when combined with Linezolid.
Betahistine Furazolidone	The metabolism of Betahistine can be decreased when combined with Furazolidone.
Betahistine Procaine	The metabolism of Betahistine can be decreased when combined with Procaine.
Betahistine Tranylcypromine	The metabolism of Betahistine can be decreased when combined with Tranylcypromine.
Betahistine Phenelzine	The metabolism of Betahistine can be decreased when combined with Phenelzine.