From the Guidelines
Betahistine (Serc) is typically dosed at 48 mg/d or 144 mg/d, with no significant difference in efficacy between the two doses, and should be used with caution in patients with asthma and history of peptic ulcer disease. The dosing of betahistine is based on the BEMED trial, a well-designed study that found no significant differences in mean attack rate per 30 days between the placebo and betahistine groups evaluated at 7 to 9 months of the treatment period 1. The study compared low-dose betahistine (48 mg/d) and high-dose betahistine (144 mg/d) to placebo, and found a significant decline in vertigo attacks across all groups over the 9-month treatment period.
Some key points to consider when prescribing betahistine include:
- Serious medical side effects with betahistine are rare, but reported side effects included headache, balance disorder, nausea, nasopharyngitis, feeling hot, eye irritation, palpitations, and upper gastrointestinal symptoms 1
- Betahistine should be avoided in patients with pheochromocytoma 1
- The length of time that betahistine should be used for is not clear, but most studies covered only a 2- to 12-week period, although the newest study covered a 9-month treatment window 1
- The clinician and patient should discuss titrating down or stopping the medication once the patient’s symptoms subside 1
It is essential to monitor patients for intolerance of medication or side effects and to reassess them as often as clinically warranted for an improvement or stabilization of symptoms 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 dosing for Serc (Betahistine) is:
- 10 drops
- Taken up to 3 times per day
- For adults and children 12 years and over
- Placement: under the tongue, 30 minutes before/after meals 2
From the Research
Dosing for Serc (Betahistine)
- The dosing for Serc (Betahistine) varies depending on the condition being treated and the patient's response to the medication.
- For the treatment of vertigo in patients with migraine, a dose of 16 mg, 3 times daily before meals, has been used 3.
- In patients with severe Menière's disease, high dosages of betahistine dihydrochloride between 288 and 480 mg/day have been effective in reducing the frequency and severity of vertigo 4.
- For the treatment of Meniere's disease, a dose of 3 x 16 mg of Betahistine has been used, with a better effect noticed after one month of therapy compared to Cinnarizine 5.
- The usual dose range for betahistine is from 8-48 mg daily, with 48 mg daily for 3 months being an effective and safe option for the treatment of peripheral vertigo 6.
- A study comparing twice and three times daily dosing of betahistine found that the twice daily dosing of 24 mg for 4 weeks and 12 mg for 8 weeks was better tolerated and gave higher positive effects than the three times daily dosing of 16 mg for 4 weeks and 8 mg for 8 weeks 7.