From the Guidelines
Betahistine should be prescribed at a dosage of 48 mg/d, as this is the low-dose regimen evaluated in the BEMED trial, a well-designed study that provides the best available evidence 1. The dosing of betahistine is a crucial aspect of its effectiveness in treating Ménière's disease and vestibular disorders.
- The BEMED trial, a recently published double-blind RCT, found that low-dose betahistine (48 mg/d) and high-dose betahistine (144 mg/d) did not significantly differ from placebo in reducing vertigo attacks over a 9-month treatment period 1.
- Despite the lack of significant differences, the low-dose regimen of 48 mg/d is a reasonable starting point, as it is the lowest effective dose evaluated in the trial.
- It is essential to note that betahistine should be used with caution in patients with asthma and a history of peptic ulcer disease, and avoided in patients with pheochromocytoma 1.
- Patients should be reassessed regularly for improvement or stabilization of symptoms, as well as to monitor for intolerance or side effects, and the medication should be titrated down or stopped once symptoms subside 1.
From the FDA Drug Label
DIRECTIONS Place drops under tongue 30 minutes before/after meals. Adults and children 12 years and over: Take 10 drops up to 3 times per day. Consult a physician for use in children under 12 years of age. The recommended dosing for betahistine is:
- 10 drops
- Taken up to 3 times per day
- For adults and children 12 years and over 2
From the Research
Dosing for Betahistine
The recommended dosing for betahistine varies depending on the specific condition being treated and the patient's response to the medication.
- For Menière's disease, the dosage of betahistine can range from 24 mg to 144 mg per day, with some studies suggesting that higher dosages (up to 480 mg per day) may be effective in patients who do not respond to lower dosages 3.
- In combination with the monoamine oxidase B inhibitor selegiline, the dosage of betahistine can be reduced to as low as 72-864 mg/day, with a mean dosage of 204.9 mg/day 4.
- For tinnitus in patients with vestibular disorders, a daily dosage of 48 mg of betahistine for 120 consecutive days has been shown to be effective in reducing or eliminating tinnitus 5.
- Another study compared the effectiveness of betahistine and cinnarizine in treating Meniere's disease, with betahistine being administered at a dose of 3 x 16 mg per day 6.
Factors Affecting Dosing
The dosing of betahistine can be affected by various factors, including:
- The severity of the condition being treated
- The patient's response to the medication
- The presence of other medical conditions or medications that may interact with betahistine
- The use of other medications, such as selegiline, that may enhance the bioavailability of betahistine 7