What is the generic version of Serc (Betahistine) and its typical dosage?

Generic Name and Dosing of Serc

The generic name of Serc is betahistine (betahistine hydrochloride or betahistine dihydrochloride), with a standard dosage of 48 mg daily for vestibular vertigo and Ménière's disease. 1

Generic Formulations

• Betahistine is the active pharmaceutical ingredient in Serc, available in multiple generic formulations worldwide 1, 2
• Common tablet strengths include 8 mg, 16 mg, and 24 mg, though modified-release formulations of 48 mg once daily are also available 3

Standard Dosing Recommendations

For Ménière's Disease and Vestibular Vertigo

• The recommended dose is 48 mg daily, typically divided as 16 mg three times daily before meals 1, 4, 5
• Treatment duration should be at least 3 months to properly evaluate efficacy 1
• Modified-release formulations allow for 48 mg once daily dosing, which has demonstrated non-inferiority to the traditional 24 mg twice daily regimen 3

Dose-Response Considerations

• Higher doses of 144 mg/day have not shown significant improvement compared to the standard 48 mg/day dose in high-quality trials 1
• The 16 mg three times daily regimen (total 48 mg) remains the evidence-based standard 1, 4, 6, 7

Clinical Indications

Betahistine is specifically indicated for:

• Ménière's disease maintenance therapy to reduce frequency and severity of vertigo attacks 1, 2
• Definite Ménière's disease requires 2 or more episodes of vertigo lasting 20 minutes to 12 hours AND fluctuating or nonfluctuating sensorineural hearing loss, tinnitus, or aural pressure 1
• Peripheral vestibular vertigo as maintenance therapy 1, 2

Critical Safety Information

Absolute Contraindications

• Betahistine is completely contraindicated in pheochromocytoma 1, 2, 8

Use With Caution

• Patients with asthma 1, 2, 8
• History of peptic ulcer disease 1, 2, 8

Common Side Effects

• Headache (most frequently reported) 1, 8, 3
• Balance disorder 1
• Nausea and upper gastrointestinal symptoms 1

Treatment Duration and Monitoring

• If no improvement in vertigo symptoms after 6-9 months of treatment, continued betahistine therapy is unlikely to be beneficial 1, 2
• Patients should be reassessed regularly for improvement or stabilization of symptoms and to monitor for medication intolerance 1, 2
• No routine laboratory monitoring is required due to betahistine's excellent safety profile over 40 years of clinical use 8

Important Clinical Pitfalls to Avoid

• Do not use betahistine for benign paroxysmal positional vertigo (BPPV) - canal repositioning maneuvers are superior (78.6%-93.3% improvement vs 30.8% with medication) 1, 2
• Avoid combining betahistine with vestibular suppressants like prochlorperazine at initiation, as this increases orthostatic hypotension, dizziness, and sedation risk without proven benefit 1, 2
• Never prescribe to patients with pheochromocytoma 1, 2, 8