- Independent review discusses evidence supporting the use of betahistine to alleviate residual dizziness following physical repositioning procedures in benign paroxysmal positional vertigo (BPPV) patients
- Betahistine is marketed world-wide, except in the US, and considered standard of care treatment for dizziness / vertigo
- AM-125 is a nasal spray formulation of betahistine currently being developed by Altamira to overcome low bioavailability of oral formulation and make treatment option also available to US patients
- Altamira intends to partner or divest AM-125 as part of legacy assets in strategic pivot to RNA delivery technology
BPPV is characterized by repeated episodes of vertigo produced by changes in the head position relative to gravity, e.g. when tipping the head backward. It is typically caused by dislodged inner ear particles (otoconia) in one of the semicircular canals, most often the posterior canal. The debris elicits unwanted vestibular stimulation and is often cleared through physical repositioning procedures such as the Epley maneuver, which is strongly recommended by the Clinical Practice Guideline of the
BPPV is the most common type of vertigo and accounts for 17 to 42% of all diagnosed cases; in
Even in case of a successful physical repositioning procedure, patients may experience residual dizziness. This may last for a few days up to several weeks and may affect quality of life and be of incapacitating nature. Residual dizziness may be due to, among others, remaining otoconia, incomplete vestibular compensation or microcirculation dysfunction. Based on their review of available treatment options, the authors of the publication suggest the use of vestibular habituation therapies and vestibular rehabilitation programs to facilitate vestibular compensation and treatment with betahistine for improvement of inner ear blood supply and promotion of vestibular compensation. An earlier publication by another research group had already shown in a meta-analysis that the combination of a common physical repositioning procedure with betahistine treatment resulted in a significantly greater reduction in dizziness handicap compared to the procedure alone (p = 0.001).2
“We welcome the additional research into residual dizziness after physical repositioning procedures in BPPV since this is a very common and oftentimes serious problem for patients”, commented
About Betahistine
Betahistine, a small molecule structural analog of histamine, acts as an agonist at the H1 histamine receptor and as an antagonist at the H3 histamine receptor. Unlike histamine, it crosses the blood-brain-barrier. Betahistine is known to increase the release of histamine, acetylcholine, dopamine and norepinephrine in the brain. It increases cochlear, vestibular and cerebral blood flow and facilitates vestibular compensation and inhibits neuronal firing in the vestibular nuclei. Betahistine for oral administration is approved in about 115 countries (with the
About AM-125
AM-125 is an intranasal formulation of betahistine. Because of its ability to circumvent first-pass-metabolism, AM-125 has been shown to have 5-to-29 times higher bioavailability than orally administered betahistine.
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1 Özgirgin et al. (2024), Residual dizziness after BPPV management: exploring pathophysiology and treatment beyond canalith repositioning maneuvers, Front Neurol 15:1382196. https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2024.1382196/full
2 Li et al. (2023), Efficacy of Epley’s maneuver plus betahistine in the management of PC-BPPV - A systematic review and meta-analysis, Medicine (
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