What is the recommended dose of Betaserc (Betahistine) for treating vertigo?

Betahistine (Betaserc) Dosing for Vertigo

The standard dose of betahistine for vertigo is 48 mg daily (typically divided as 16 mg three times daily), with treatment duration of at least 3 months required to properly evaluate efficacy. 1

Recommended Dosing Regimen

Standard Dose:

• 48 mg daily total dose (16 mg three times daily) is the evidence-based standard for vertigo treatment 1, 2
• Treatment should continue for minimum 3 months before assessing efficacy 1, 2
• Higher doses (144 mg/day) have not demonstrated superior efficacy compared to 48 mg/day in high-quality trials 1, 2

Acute Phase Dosing:

• For acute vestibular symptoms, 16 mg three times daily (48 mg total) is recommended 3
• Some clinicians use 8 mg dosing, but 16 mg three times daily shows better outcomes in acute phases 3

Indication-Specific Considerations

Ménière's Disease (Primary Indication):

• Betahistine is indicated as maintenance therapy for definite or probable Ménière's disease to reduce frequency and severity of vertigo attacks 1
• Requires diagnosis of 2+ episodes of vertigo lasting 20 minutes to 12 hours with fluctuating sensorineural hearing loss, tinnitus, or aural pressure 1
• Standard 48 mg daily dosing for at least 3 months 1, 4

Benign Paroxysmal Positional Vertigo (BPPV):

• Betahistine is NOT routinely recommended for BPPV as primary treatment 5, 1
• Particle repositioning maneuvers demonstrate 78.6-93.3% improvement versus only 30.8% with medication alone 1
• May be used only for residual dizziness after successful repositioning or to reduce severity during maneuvers 4

Peripheral Vestibular Vertigo:

• 48 mg daily shows positive effect with 73% cumulative complete improvement by 12 weeks 6
• Average improvement of 56.6 points (0-100 scale) after first week, reaching 89.3 points by week 12 6

Treatment Duration and Monitoring

Reassessment Timeline:

• Evaluate for symptom improvement, stabilization, or medication intolerance regularly 1, 2
• If no improvement after 6-9 months, continued therapy is unlikely to be beneficial and should be discontinued 1, 2
• Track vertigo frequency/severity, associated tinnitus, hearing loss, and aural fullness 1

Critical Contraindications and Precautions

Absolute Contraindication:

• Pheochromocytoma - betahistine is completely contraindicated 1, 7, 2

Use with Caution:

• Asthma patients 1, 7
• History of peptic ulcer disease 1, 7

Common Side Effects:

• Headache, balance disorder, nausea, upper gastrointestinal symptoms 1, 2
• Generally well-tolerated with no sedative effects, suitable for long-term use 3

Important Clinical Pitfalls

Avoid These Common Errors:

• Do not use betahistine as first-line treatment for BPPV - repositioning maneuvers are superior 5, 1
• Do not continue beyond 6-9 months without documented benefit 1, 2
• Do not use for acute vertigo episodes requiring immediate symptom control - prochlorperazine is more appropriate for acute management 2
• Do not start both betahistine and prochlorperazine simultaneously as this prevents assessment of individual medication efficacy 1