Betagistin-Teva instructions for use

Betahistine is a tablet drug. It is used to relieve symptoms that appear against the background of malfunctions of the vestibular apparatus associated with impaired functioning of the central nervous system.

Betahistine tablets, the instructions focus on this, are used to treat Meniere's syndrome. Typically, the disease is confirmed when problems with hearing function or coordination appear. Additional signs are frequent, causeless dizziness. In the acute stage, symptoms manifest as a stroke. If left untreated, a secondary attack can be life-threatening.

The drug is also used for symptomatic treatment of vestibular dizziness - vertigo. Its causes are most often inflammatory diseases of the inner ear, as well as traumatic brain injury, intoxication and metabolic disorders.

pharmachologic effect

Betahistine is a histamine created synthetically. Basically, the active substance of the drug is capable of engaging histamine H-1 and H-3 receptors (weak and strong antagonists) of the central nervous system. In this case we are referring to the receptors of the inner ear and vestibular nuclei.

Betahistine dihydrochloride affects blood flow, stimulating microcirculation and permeability of the capillaries of the inner ear. In addition, the active ingredient of this drug stabilizes the endolymph pressure in the cochlea and labyrinth.

Due to the fact that Betahistine is essentially an inhibitor of H-3 receptors in the nuclei of the vestibular apparatus, this drug has a pronounced effect on the central nervous system, stabilizing neuronal transmission in the neurons of the vestibular nucleus.

Betahistine, when taken correctly, can very quickly neutralize the symptoms of vestibular vertigo . The period of exposure to the active substance of this drug ranges from several minutes to 24 hours. Regular use of Betagistine under medical supervision will reduce the frequency and effectiveness of dizziness, reduce noise and ringing in the ears in patients, and also restore hearing if it worsens. The drug does not have a sedative effect and does not cause various coordination disorders. Does not affect the endocrine glands.

Interactions

In vivo studies examining the interaction of betahistine with other drugs have not been conducted. In vitro data suggest no inhibition of cytochrome p450 enzyme activity in vivo.

Data obtained in vitro indicate inhibition of betahistine metabolism by drugs that inhibit MAO activity, including MAO subtype B (for example, selegiline). Betahistine and MAO inhibitors (including selective MAO subtype B) should be used with caution.

Betahistine dihydrochloride is a histamine analog, and concomitant use of histamine H1 receptor antagonists may affect the effectiveness of either drug.

Pharmacodynamics and pharmacokinetics

Betahistine is quickly and completely absorbed after oral administration of the drug in tablets. Peak plasma concentrations of the active substance of the drug are achieved approximately one hour after oral administration on an empty stomach. Subsequently, Betahistine binds to human plasma proteins, but it is worth noting a very low level of binding - less than 5%.

In blood plasma, the maximum concentration of the active substance is reached after approximately 60 minutes. It is excreted from the body as a result of metabolism by metabolization to inactive metabolites - 2-pyridylacetic acid (the main metabolite) and demethylbetagistine .

Almost complete elimination of the drug substances occurs within 24 hours, mainly through the kidneys (approximately 90%), the remaining 10% is excreted through the intestines and liver.

Pharmacological properties

Pharmacodynamics.
betahistine dihydrochloride is a synthetic analogue of histamine for oral use. The mechanism of action of betahistine has only been partially studied. There are several credible hypotheses that are supported by data from animal and human studies. Effect of betahistine on the histaminergic system. It has been established that betahistine partially exhibits agonistic activity towards H1 receptors, as well as antagonistic activity towards histamine H3 receptors in nervous tissue and has insignificant activity towards histamine H2 receptors. Betahistine increases the metabolism and release of histamine by blocking presynaptic H3 receptors and inducing a decrease in the number of corresponding H3 receptors.

Effect on increasing blood flow to the cochlear area, as well as to the entire brain. Pharmacological studies in animals have demonstrated improved blood circulation in the stria vascularis of the inner ear, possibly due to relaxation of the precapillary sphincters in the microcirculatory system of the inner ear. Betahistine also causes an increase in cerebral blood flow in the human body.

Promoting vestibular compensation. Betahistine accelerates the recovery of vestibular function after unilateral neurectomy in animals, accelerating and promoting the process of vestibular compensation. This effect is achieved by increasing the metabolism and release of histamine and is realized as a result of antagonism of H3 receptors. In humans, treatment with betahistine also reduced the time to recovery of vestibular function after neurectomy.

Influence on the activity of neurons in the vestibular nuclei. It has been established that betahistine has a dose-dependent inhibitory effect on the generation of peak potentials in neurons of the medial and lateral vestibular nuclei.

The pharmacodynamic properties of betahistine, as shown in animals, provide a positive therapeutic effect of the drug on the vestibular system.

The effectiveness of betahistine has been shown in studies in patients with vestibular vertigo and Meniere's disease, which was manifested by a decrease in the severity and frequency of dizziness attacks.

Pharmacokinetics

Suction. When administered orally, betahistine is rapidly and almost completely absorbed in all parts of the gastrointestinal tract. After absorption, the drug is quickly and almost completely metabolized to form the metabolite 2-pyridylacetic acid. The plasma concentration of betahistine is very low. Therefore, all pharmacokinetic analyzes are carried out by measuring the concentration of the metabolite 2-pyridylacetic acid in blood plasma and urine.

When taking the drug with food, Cmax of the drug is lower than when taken on an empty stomach. However, the complete absorption of betahistine is identical in both cases, which indicates that food intake only slows down the absorption process of the drug.

Distribution. The proportion of betahistine that binds to plasma proteins is less than 5%.

Biotransformation. After absorption, betahistine is quickly and almost completely metabolized into 2-pyridylacetic acid (which does not exhibit pharmacological activity). After taking betahistine orally, the Cmax of 2-pyridylacetic acid in the blood plasma and urine is reached 1 hour after taking the drug and decreases with a half-life of about 3.5 hours.

Excretion. 2-pyridylacetic acid is rapidly excreted in the urine. When taking the drug at a dose of 8–48 mg, about 85% of the initial dose is determined in the urine. Excretion of betahistine by the kidneys or feces is insignificant.

Linearity. The rate of recovery remains constant at oral doses of 8–48 mg, indicating linear pharmacokinetics of betahistine and suggesting that the metabolic pathway involved is unsaturable.

Indications for use of Betagistine

Indications for the use of Betahistine are as follows: treatment of Meniere's syndrome , as well as symptoms that may include dizziness, tinnitus, partial hearing loss, nausea, and loss of coordination.

Reference: Meniere's syndrome manifests itself in the form of vestibular and auditory disorders that have not previously been observed in humans. May develop as an acute stroke . Has a high probability of subsequent relapse.

Side effects

Along with the obvious beneficial effects, taking Betahistine can cause side effects.

Attention: not every patient taking this drug will experience discomfort or experience at least one of the side effects listed below.

Experts warn that side effects when taking any drug are not always interpreted in a negative way. As a rule, in most cases, any reaction may indicate the body's adaptation to a new drug, so before deciding to stop using the drug, you should consult your doctor.

Common side effects from taking Betahistine occur in one in ten patients who take this medicine. The list of the most common side effects includes symptoms such as:

• general poor health;
• stomach upset (occurs when taking the drug before meals, which is strictly contraindicated);
• headache (in this case, you should take a painkiller, according to the preliminary recommendation of a specialist);
• bloating or discomfort;
• allergic skin reactions, such as hives and rashes (if such reactions occur, use an antihistamine or apply moisturizer to problem areas of the skin).

If these recommendations do not help eliminate side effects, the patient must consult a doctor before taking the next dose of Betahistine.

Side effects

The following adverse reactions were observed in patients with the following frequencies: very often (≥1/10), often (≥1/100 to 1/10), uncommon (≥1/1000 to 1/100), rarely (≥1/100). 10,000 to 1/1000), very rare (1/10,000), frequency unknown (cannot be determined from available data).

From the digestive system: often - nausea and dyspepsia.

From the nervous system: often - headache.

In addition to those reported in clinical studies, the following side effects have been spontaneously reported during post-marketing use and are known from the scientific literature. The frequency cannot be determined from the available data, so it is classified as unknown.

Adverse reactions, the frequency of which is unknown.

From the immune system: hypersensitivity reactions, such as anaphylaxis.

From the gastrointestinal tract: complaints of minor stomach upsets (vomiting, gastrointestinal pain, bloating and flatulence). These side effects usually go away when the drug is taken with food or when the dose is reduced.

From the skin and subcutaneous tissue: hypersensitivity reactions of the skin and subcutaneous fat have been observed, in particular angioedema, rash, itching and urticaria.

Instructions for use of Betagistine (Method and dosage)

The medicine Betahistine must be taken strictly in accordance with the instructions.

Dosage for adults

Anti-dizziness tablets must be taken with food or after meals at a dosage of 8 or 16 mg three times a day during the initial stage of treatment with this drug.

Maintenance doses of the drug usually range from 24 to 48 mg per day at the discretion of the attending physician. The daily dose should not exceed 48 mg. The dosage can be adjusted taking into account the individual health characteristics of patients. Sometimes improvement may only be seen after several weeks of treatment.

Treatment of patients with liver, kidney and heart failure

For patients with liver failure, treatment with Betahistine should be prescribed after a thorough study. Treatment of patients with renal and heart failure is also prescribed.

Treatment of elderly patients

In old age, Betahistine should be used with caution, since in this population group there is a high probability of negative reactions from the body to the active and auxiliary substances included in the medicine.

Betahistine, instructions for use for children and adolescents

Betahistine tablets are not recommended for use in children and adolescents under the age of 18 due to the lack of data on the safety and effectiveness of the drug.

Taking medication

Positive results appear in the first days after starting treatment with the drug. After two weeks of use, a stable therapeutic effect is recorded. When treated with betahistine for several months, the condition of patients with Meniere's syndrome improves significantly.

Understanding what betahistine is prescribed for, you need to know how to take the tablets. The dosage is prescribed individually by the doctor, taking into account the patient’s condition. The maximum daily dose is 48 mg. Taking tablets is indicated during meals. 2-3 times a day. The recommended course duration is 2 - 3 months. Sometimes periodic treatment is carried out.

Correction during treatment is usually not required. The effectiveness of the drug decreases when combined with other antihistamines. Betahistine does not have sedative properties, so there are no restrictions regarding driving a car during treatment. It is also allowed to work on various complex mechanisms without any restrictions.

Overdose

General information on cases of overdose with Betahistine has not been reported. It is known that some patients experienced mild to moderate symptoms such as headache, nausea, drowsiness and abdominal pain when taking the drug at a dose of up to 640 mg.

Other symptoms of overdose: vomiting, dyspepsia , ataxia and convulsions .

More serious complications: seizures, pulmonary or cardiovascular complications have been observed in cases of intentional overdose of the drug, especially in combination with other drugs. There is no specific antidote, so in case of overdose with this medicine, gastric lavage is recommended within one hour after administration.

Contraindications

Absolute contraindications are hypersensitivity to the active substance and other components of the product. Treatment with the drug is not prescribed until adulthood. The drug is contraindicated during pregnancy and lactation, since there is no data on its effect on the fetus and newborn child. Betahistine should not be used if you are lactose intolerant. Caution should be exercised when prescribing medication when the following diseases are diagnosed:

• Peptic ulcer of the stomach or duodenum.
• Pheochromocytoma.
• Bronchial asthma.

It is not recommended to use betahistine, the instructions for use indicate this, in combination with antihistamines. In addition, it is recommended to refuse the product if:

• Hives.
• Arterial hypotension.
• Allergic rhinitis.

Since studies on the reaction to the drug in renal and hepatic failure have not been conducted, it is recommended to refuse treatment for these pathologies.

Betagistine's analogs

Level 4 ATX code matches:
Betagis

Stugeron

Betaserk

Betaver

Westinorm

Westicap

Tagista

Vestibo

Cinnarizine

Analogues of Betagistine, similar in composition and effective effect on the body:

• Alfaserk
• Asniton
• Betaver
• Betagistin-Nanolek
• Betagistin-SZ
• Betahistine hydrochloride
• Betahistine dihydrochloride
• Betaserk
• Vestibo
• Westicap
• Microzer
• Tagista

Reviews about Betagistine

As is the case with all medications, reviews of Betagistine are not always positive. On specialized forums you can often find reviews about the drug that indicate that the effect is not always stable. Therefore, most people suffering from chronic disorders of the cardiovascular system are forced to resort to taking these pills regularly. But this does not guarantee relief from headaches and dizziness.

However, there are many positive reviews. For example, several women wrote that during the onset of menopause they began to experience wild headaches and attacks of dizziness, which did not allow them to even slightly tilt their heads down, since at these moments they completely lost coordination. After prescribing Betahistine, these symptoms disappeared completely, clarity of mind and lightness appeared throughout the body.

Both positive and negative reviews indicate that this drug requires very careful use - for some disorders it can completely restore health, but for others, on the contrary, it will not have the expected effect, but will only reduce the manifestation of symptoms.

Note!

Description of the drug Betagistin-Teva table. 24mg No. 20 on this page is a simplified author’s version of the apteka911 website, created on the basis of the instructions for use.
Before purchasing or using the drug, you should consult your doctor and read the manufacturer's original instructions (attached to each package of the drug). Information about the drug is provided for informational purposes only and should not be used as a guide to self-medication. Only a doctor can decide to prescribe the drug, as well as determine the dose and methods of its use.

Betagistin price, where to buy

The price of Betahistine may vary and depends on the number of tablets in the package. For example, the price of Betagistin 24 mg No. 30 varies from 100 to 300 rubles, which, by the way, does not affect the demand for this drug. Many consumers believe that such a low cost of the drug is an additional plus to its obvious advantages.

• Online pharmacies in RussiaRussia
• Online pharmacies in UkraineUkraine
• Online pharmacies in KazakhstanKazakhstan

ZdravCity

• Betahistine-SZ tablets 24 mg 30 pcs. North Star ZAO
  187 rub. order
• Betahistine tablets 16 mg 30 pcs. Ozon LLC

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  110 rub. order

• Betahistine-Akrikhin tablets 16 mg 30 pcs. Abdi Ibrahim Ilyach Sanayi ve Tij. A.Sh.

  136 RUR order

• Betahistine Canon tablets 24 mg 30 pcs. JSC Kanonpharma Production

  125 rub. order

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  RUB 131 order

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Pharmacy24

• Betahistine-KV 16 mg N30 tablets PAT "Kiev Vitamin Plant", Kiev, Ukraine
  76 UAH. order
• Betagistin-Teva 24 mg No. 20 tablets Merkle GmbH, Nimechchina

  121 UAH order

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  109 UAH order

• Betahistine-KV 8 mg N30 tablets PAT "Kiev Vitamin Plant", Kiev, Ukraine

  55 UAH order

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Betahistine – harmony of balance

About the article

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Regular issues of "RMZh" No. 20 dated 09/03/2009 p. 1366

Category: Neurology

Author: Ratbil O.E.

For quotation:

Ratbil O.E. Betahistine – harmony of balance. RMJ. 2009;20:1366.

The only beauty I know is health.

Heinrich Heine

Dizziness is one of the most common symptoms in medical practice. Among outpatients visiting doctors of all specialties, dizziness is the main complaint in 2–5% of cases. The cause of dizziness is an imbalance of sensory information coming from the main afferent systems that provide spatial orientation - vestibular, visual and proprioceptive. Dizziness is also one of the most common symptoms in patients with ischemic cerebral disease, especially with pathology of the vertebrobasilar system. In this group of patients, dizziness is usually caused by age-related changes in the sensory system, a decrease in the compensatory capabilities of the central mechanisms for maintaining balance, and cerebrovascular insufficiency with a predominant lesion of the vertebrobasilar system. In this case, changes in the vestibular nuclei of the trunk or vestibulo-cerebellar connections play a major role, but the so-called peripheral component, caused by atherosclerotic lesions of the vessels of the inner ear, also plays a certain role. In the clinic of neurological manifestations of cervical osteochondrosis, a special place is occupied by syndromes accompanied by severe dizziness. This is the so-called vertebrogenic vertebral artery syndrome, or posterior cervical sympathetic syndrome, which is caused by the impact of pathological bone and cartilage structures on the vertebral artery. Most often, the wall of the vessel is affected by uncovertebral growths, which deform the medial wall of the vessel or injure the surrounding sympathetic plexus, causing spasm of the artery and its branches. Manifestations of the syndrome unfold in the areas of vascularization of the branches of the vertebral artery. The clinical picture consists of headaches of occipital localization with frontal distribution, visual (in the form of subjective sensations of “fog”, “sand in the eyes”) and cochleovestibular disorders. The latter often come to the fore and are manifested by systemic and non-systemic dizziness, sometimes with nausea, vomiting, paraacusis (noise, hum, crackling) and hearing loss on the affected side. It should also be noted that there is a high incidence of dizziness (more than 20%) as a symptom in patients who have suffered uncomplicated concussions. The histaminergic system plays an important role in the functioning of the vestibular structures. Thus, the transmission of impulses from vestibular receptors and vestibular nuclei is provided primarily by histaminergic neurons. The main source of histaminergic innervation is the posterior hypothalamus, mainly the tuberomammillary nucleus, whose neurons are associated with almost all structures of the diencephalic region and telencephalon, including the basal ganglia and cortex, as well as with the brainstem and, in particular, with the vestibular nuclei complex. Histaminergic innervation is most represented in the medial vestibular nucleus. In peripheral vestibular disorders, there is an increase in spontaneous impulses of neurons of the ipsilateral vestibular nuclei, mainly the medial one. At the same time, there is a decrease in the expression of GABA receptors, which leads to the predominance of stimulating histaminergic influences. In addition, there is an increase in the density of GABA receptors in the contralateral medial vestibular nucleus. The histaminergic system also ensures the transmission of excitation between the vestibular nuclei and the vomiting center. Serotonergic, noradrenergic and dopaminergic innervation has a certain significance in the formation of connections of the vestibular system. One of the drugs that has a structural similarity to histamine and an affinity for blocking H3 receptors and stimulating H1 receptors is Tagista, containing betahistine hydrochloride. Due to the blockade of H3 receptors, Tagista increases the release of neurotransmitters from the nerve endings of the presynaptic membrane, has an inhibitory effect on the vestibular nuclei of the brain stem and improves blood supply to the inner ear. Betahistine was registered as a drug in Europe in 1970; it is a synthetic drug that has the ability to bind to H1 histamine receptors, which are located in the neuroreceptor cells of the inner ear. It has a local powerful stimulating effect, increasing the release of neurotransmitters (histamine) from the nerve endings of the receptor cells of the inner ear into the synapse. Neurotransmitters act on the precapillary sphincters, causing vasodilation of the vessels of the inner ear, increasing their permeability and thereby normalizing intralabyrinthine pressure, i.e. eliminating hydrops. In addition to affecting the receptors of the inner ear, betahistine has an effect on the receptors of the vestibular nuclei located in the medulla oblongata. Experimental work on animals has shown an increase in serotonin levels in the medulla oblongata. This leads to a decrease in the activity of the vestibular nuclei, a decrease in their excitability and the cessation of dizziness. Thus, a vestibulodepressive effect is manifested. The effectiveness of Tagista is associated with a decrease in both spontaneous and evoked impulses from vestibular receptors and vestibular nuclei. It was shown that the administration of betahistine led to a dose-dependent decrease in the frequency of spontaneous impulses from semicircular tubule receptors. In addition, Tagista helps to reduce the intensity and amplitude of impulses of neurons of the lateral vestibular nucleus both at rest and during stimulation. Tagista also stimulates the synthesis of endogenous histamine, as evidenced, in particular, by the increased synthesis of messenger RNA encoding histidine decarboxylase, the main enzyme in histamine synthesis. Along with the effect on histamine receptors in the peripheral and central vestibular structures, Tagista has a vasoactive effect. The drug causes dilation of the arterioles and capillaries of the inner ear, which leads to a selective increase in blood flow. In addition, taking the drug contributes to a slight increase in cerebral blood flow both in the vertebrobasilar and carotid areas, which leads to an improvement in cognitive functions in patients with chronic cerebrovascular insufficiency (Table 1). The administration of betahistine reduces the frequency, severity and duration of attacks of systemic dizziness (Table 2). Along with the positive effect on vestibular function, there is also an improvement in hearing during treatment, which is apparently due to the vasoactive effect of the drug. During a study of the effectiveness of betahistine [A.B. Gekht, 2001] in elderly patients with chronic vertebrobasilar insufficiency, significant positive dynamics of cochleovestibular disorders proper (dizziness, hearing loss, ataxia) were revealed. There was also a decrease in headaches and visual field defects. High tolerability of betahistine is very important when used in elderly patients with concomitant somatic pathology. Betahistine is also effective for relieving attacks of acute dizziness (vertigo). The drug reduces the frequency, duration and severity of attacks. Until recently, the medical trend has been to control very severe attacks of vertigo with labyrinthine drugs (prochlorperazine). Sedation, or drowsiness, is a common side effect of these drugs, which delay vestibular compensation [Kirtane, 1999]. Tagista at a dose of 16 mg 3 times a day. – best choice for controlling acute dizziness. In the clinic of acute vertigo, which occurs largely due to imbalances in electrical potentials in the vestibular nuclei of both hemispheres, the following tendency is revealed: during the acute phase, cerebellar cells inhibit the vestibular nuclei and thereby alleviate symptoms. This phenomenon is very figuratively called “cerebellar clamp”. Gradually, over several weeks, the vestibular nuclei of the undamaged side take over the function of the affected nuclei. This is observed anatomically as the emergence of cross-synapses and leads to a balance in the impulse activity of the nuclei of both sides. Once this happens, the vestibular nuclei are gradually released from the “cerebellar clamp” effect. This whole process is called “compensation”, thanks to which a person or animal who has suffered from acute attacks of vertigo regains a sense of balance, even if the original pathology is irreversible (Fig. 1-3). Most medications for dizziness cause sedation and CNS depression. This slows down the compensation process, which is so necessary for the patient's rehabilitation. Betahistine, which does not cause CNS depression, does not interfere with the compensation process. Tagista is not a sedative and therefore does not interfere with the patients’ normal lifestyle. The drug really has an “acceleration” effect on vestibular adaptation, which is vital for the speedy rehabilitation of patients with acute peripheral vestibular catastrophe. Biswas (1998), Tighilet et al. (1995) concluded from observations that taking betahistine per os (50 or 100 mg/per 1 kg of body weight) significantly accelerates recovery, restores statics and dynamics after transection of the left vestibular nerve in experimental cats and thus significantly accelerates vestibular compensation. Tagista is available in tablets of 8, 16 and 24 mg. The optimal daily dose is 48 mg. The most adequate therapeutic effect is achieved when taking the drug with food. The drug should be used with caution in patients suffering from peptic ulcer of the gastrointestinal tract (including a history of it), pheochromocytoma, and bronchial asthma. These patients should be monitored regularly during treatment. The duration of treatment in all cases is determined by the attending doctor, taking into account the clinical picture and individual characteristics of the patient.

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