Betahistine Dosing for Adults
The standard recommended dose of betahistine for adults is 48 mg per day, typically divided into multiple doses, for the treatment of vestibular vertigo and Ménière's disease. 1
Standard Dosing Regimen
- Initial dose: 25-30 mg daily for 2-4 weeks, which allows gradual onset of tolerance to side effects 1
- Maintenance dose: 48 mg daily is the evidence-based standard dose that has demonstrated efficacy in clinical trials 1, 2, 3
- Dose range: 25-50 mg daily for most patients, with a maximum of 75 mg daily in select cases 1
- Administration: Take once daily with meals or milk, though the dose can be divided 1
Treatment Duration and Efficacy
- Minimum treatment duration: At least 3 months is required to properly evaluate therapeutic efficacy 1
- Optimal response time: Peak therapeutic effect typically requires 3-6 months of continuous treatment 1
- Higher doses not superior: Studies show that 144 mg/day does not provide significant improvement over 48 mg/day or placebo 1
Dose-Response Evidence
The evidence strongly supports 48 mg daily as the optimal dose. A dose-response study demonstrated that at 3-4 hours post-dose, vestibular nystagmus duration was reduced by 35% with 8 mg, 48% with 16 mg, and 59% with 32 mg (all highly significant at P < 0.0005) 4. This supports dosing of 3 × 8 mg (24 mg daily) for maintenance or 3 × 16 mg (48 mg daily) for greater effect 4.
Clinical Context and Indications
- Primary indication: Ménière's disease maintenance therapy to reduce frequency and severity of vertigo attacks 1, 5
- Diagnostic criteria: Use in patients with definite or probable Ménière's disease (≥2 episodes of vertigo lasting 20 minutes to 12 hours with fluctuating sensorineural hearing loss, tinnitus, or aural pressure) 1, 5
- Not recommended for: Benign paroxysmal positional vertigo (BPPV), where canal repositioning maneuvers are superior (78.6-93.3% improvement vs 30.8% with medication) 1, 5
Absolute Contraindications and Precautions
- Absolute contraindication: Pheochromocytoma 1, 6, 5
- Use with caution: Asthma and history of peptic ulcer disease 1, 6, 5
- Common side effects: Headache, balance disorder, nausea, and upper gastrointestinal symptoms 1
When to Discontinue
If no improvement in vertigo symptoms occurs after 6-9 months of treatment at 48 mg daily, continued betahistine therapy is unlikely to be beneficial and should be discontinued 1.