From the Guidelines
The recommended dosage of Vertin (betahistine) for managing vertigo is not supported by recent high-quality evidence, and its effectiveness is uncertain, therefore, it should be used with caution and only when the benefits outweigh the risks. According to the most recent and highest quality study, the BEMED trial 1, which evaluated the effect of betahistine on vertigo attacks in Ménière's disease, there were no significant differences in mean attack rate per 30 days between the placebo and betahistine groups, suggesting that betahistine may not be effective in reducing vertigo attacks. Some key points to consider when using Vertin (betahistine) include:
- The medication should be used with caution in patients with asthma and history of peptic ulcer disease, and avoided in patients with pheochromocytoma 1.
- Common side effects include headache, balance disorder, nausea, nasopharyngitis, feeling hot, eye irritation, palpitations, and upper gastrointestinal symptoms 1.
- If oral medication is initiated, the patient should be reassessed as often as clinically warranted for an improvement or stabilization of symptoms as well as to monitor for intolerance of medication or side effects 1.
- There are no clear data to suggest the length of time that these agents should be used for, but the clinician and patient should discuss titrating down or stopping the medication once the patient’s symptoms subside 1.
From the Research
Vertin Tablet (Betahistine) Dosage and Treatment Plan
The recommended dosage and treatment plan for Vertin (betahistine) in managing vertigo can be summarized as follows:
- The usual dose range for betahistine is from 8-48 mg daily 2
- A daily dose of 48 mg for 3 months has been shown to be effective in decreasing the intensity of vertigo, frequency of attacks, and stimulating vestibular compensation 3, 2
- Betahistine has been demonstrated to be effective in the treatment of peripheral vertigo, including Meniere's disease, benign paroxysmal positional vertigo (BPPV), and vestibular neuronitis 2, 4
- The efficacy and safety of betahistine have been confirmed in numerous clinical trials, with an excellent safety profile 2, 5
Treatment Duration and Follow-up
- Treatment duration can range from 2-3 months, with follow-up for 2 months after discontinuation of treatment 5
- Clinical response and vertigo severity have been shown to improve significantly during treatment, with effects persisting for 2 months after treatment cessation 5
Combination Therapy
- Combination therapy with betahistine and the MAO-B inhibitor selegiline has been shown to be effective in reducing the frequency of acute attacks of vertigo in patients with Meniere's disease, with a significantly lower dosage of betahistine needed to achieve the same treatment response 6
Dosage Forms
- A new once-daily drug formulation of modified-release betahistine has been shown to be non-inferior to traditional formulations, with a comparable safety profile 3