Is there an over-the-counter betahistine?: Prescription Status and Alternatives

October 9, 2025 •

4 min read

While betahistine is widely used globally to treat symptoms of Ménière's disease, it is not an over-the-counter (OTC) medication in most countries, including the United States, where its sale is highly restricted. This prescription-only status is crucial for ensuring the drug is used under proper medical supervision for specific inner ear disorders.

Quick Summary

Betahistine is a prescription-only medication for vertigo and inner ear disorders in most countries. In the U.S., it is not FDA-approved for vertigo but can be obtained from compounding pharmacies with a doctor's prescription. OTC alternatives for dizziness and nausea are available, though they work differently.

Key Points

Not an Over-the-Counter Medication: Betahistine is a prescription-only drug in most countries, including the UK and Canada.
Restricted in the US: In the United States, betahistine is not FDA-approved for vertigo due to a lack of proven efficacy and can only be obtained via a compounding pharmacy with a prescription.
Prescription for Safety: Betahistine's prescription status is important for ensuring proper diagnosis and monitoring by a healthcare professional, especially for conditions like Ménière's disease.
OTC Alternatives Available: Non-prescription alternatives for vertigo and nausea, such as the antihistamine meclizine (Bonine, Dramamine Less Drowsy), are available in many drugstores.
Different Mechanisms: OTC remedies like meclizine work differently than betahistine, and may cause drowsiness, unlike betahistine.
Lifestyle Changes Help: Modifying diet (low-sodium), reducing caffeine/alcohol, and managing stress are effective non-medicinal strategies for managing inner ear balance issues.

Is Betahistine Available Over-the-Counter?

The simple answer is no; betahistine is not an over-the-counter medication. It is a prescription-only drug in most regions where it is sold, including the United Kingdom and Canada. Its availability varies significantly depending on the country, which can lead to confusion for patients seeking treatment for inner ear balance issues.

The Status of Betahistine in the United States

For residents of the United States, the situation with betahistine is unique. The drug was initially approved by the FDA in the 1960s to treat vertigo but was withdrawn in 1971 due to a lack of sufficient efficacy evidence. As a result, betahistine is not currently FDA-approved for commercial sale in the U.S. and cannot be found on pharmacy shelves.

Despite this, American patients can still access the medication with a valid prescription from a doctor, but it must be prepared by a compounding pharmacy. Compounding pharmacies can create customized medications for individual patients. This method ensures that the patient receives the drug under appropriate medical supervision, though it can also mean that the cost is higher and not typically covered by insurance. Doctors may choose to prescribe betahistine through this route for patients with persistent symptoms of inner ear disorders like Ménière's disease.

Betahistine's International Availability

In contrast to the U.S., betahistine is widely available and approved in over 115 countries worldwide, including the UK, Canada, and Australia. In these nations, it is a standard prescription medication used to manage symptoms associated with Ménière's disease, such as vertigo, tinnitus, and hearing loss. Common brand names internationally include Serc, Betaserc, and Vertin. Just as in the U.S., a doctor's prescription is always required, and the medication is not available for direct purchase by the public.

How Betahistine Works

Betahistine is a histamine analogue that is believed to work by improving blood flow in the inner ear. Specifically, it acts as an H1 receptor agonist and a potent H3 receptor antagonist. This mechanism is thought to help regulate fluid balance and pressure within the labyrinth of the inner ear, thereby helping to relieve symptoms of Ménière's disease. It is important to note that it is used to manage symptoms rather than cure the underlying condition.

Over-the-Counter Alternatives for Vertigo and Dizziness

While betahistine is not available without a prescription, several over-the-counter options can provide relief for dizziness, nausea, and vertigo, though they function differently.

OTC Medication Options

Antihistamines: OTC antihistamines like meclizine (found in Bonine and Dramamine Less Drowsy) and dimenhydrinate (Dramamine) can help reduce the sensation of spinning (vertigo) and associated nausea. Meclizine and similar drugs work by suppressing vestibular sensory input to the brain. However, unlike betahistine, many of these medications have a sedative effect.
Ginger Supplements: Some people find relief from nausea associated with vertigo by using ginger supplements.

Lifestyle Modifications

Beyond medication, certain lifestyle adjustments are recommended to help manage symptoms of inner ear conditions like Ménière's disease:

Low-Sodium Diet: Limiting sodium intake to reduce fluid retention is a common recommendation.
Caffeine and Alcohol Reduction: Caffeine and alcohol can affect the body's fluid regulation and blood flow to the inner ear, potentially worsening symptoms.
Stress Management and Rest: High stress levels and lack of adequate sleep can exacerbate symptoms, making management techniques important.

Comparison Table: Betahistine vs. OTC Alternatives


Feature	Betahistine	Meclizine/Dimenhydrinate	Other OTC Options (e.g., Ginger)
Availability	Prescription-only worldwide; requires compounding pharmacy in U.S.	OTC and prescription versions widely available	Widely available OTC
Mechanism of Action	Thought to improve blood flow to inner ear; histamine analogue	Antihistamines that suppress vestibular signals to the brain	Natural supplement for nausea, exact mechanism for vertigo varies
Primary Use	Ménière's disease, vestibular vertigo	Motion sickness, general dizziness, vertigo	Symptomatic relief of nausea
Side Effects	Common: headache, nausea, indigestion. Rare: allergic reactions	Common: drowsiness. Others: dry mouth, blurred vision	Generally mild, depends on the specific supplement
Sedative Effect	Generally less sedating	Can cause significant drowsiness	Non-sedating
Long-Term Use	Can be taken long-term for chronic conditions	Not typically recommended for continuous long-term use	Safe for regular use in most people, but consult a doctor

Conclusion

For those wondering, "Is there an over-the-counter betahistine?", the definitive answer is no. Betahistine's complex regulatory history, particularly its withdrawal from the FDA's approved list, underscores the importance of a medical consultation for its use. It is a targeted treatment for specific inner ear disorders that requires professional diagnosis and supervision. For individuals experiencing dizziness, vertigo, or motion sickness, over-the-counter antihistamines like meclizine may offer temporary relief, but it is crucial to consult a healthcare provider to determine the root cause of the symptoms and decide on the most appropriate course of treatment. Exploring non-pharmacological options, such as dietary adjustments, can also be a valuable part of a comprehensive management strategy for inner ear balance issues.

For further information on vertigo and balance disorders, you can visit the Ménière's Society website.

Frequently Asked Questions

Betahistine is a powerful drug intended to treat specific inner ear conditions like Ménière's disease, and its use requires proper medical diagnosis and supervision. In the U.S., it was withdrawn from the market decades ago due to insufficient evidence of efficacy.

If you are in a country where betahistine is approved, you can obtain it from licensed online pharmacies with a valid prescription from a doctor. U.S. residents must use a compounding pharmacy with a prescription.

Betahistine is a histamine analogue thought to improve blood flow in the inner ear, while meclizine is an antihistamine that suppresses vestibular signals to the brain. Meclizine is often more sedating than betahistine.

Common side effects include headaches, nausea, and indigestion, which can often be mitigated by taking the medication with food. Serious allergic reactions are rare.

Yes, common over-the-counter options for motion sickness and dizziness include meclizine (Bonine, Dramamine Less Drowsy) and dimenhydrinate (Dramamine). Ginger supplements can also help with associated nausea.

Betahistine is specifically used to treat vertigo associated with inner ear disorders like Ménière's disease. It may not be effective for other types of vertigo, and a proper diagnosis by an ENT or other specialist is necessary.

Yes, for conditions like Ménière's disease, a low-sodium diet, reducing caffeine and alcohol intake, and managing stress are often recommended as initial management strategies.