What is the recommended dose of Betaserc (betahistine) for Meniere's disease?

Betahistine Dosing for Meniere's Disease

The recommended dose of Betaserc (betahistine) for Meniere's disease is 48 mg daily, administered either as 24 mg twice daily or as a single 48 mg modified-release formulation, with treatment continued for at least 3 months to assess efficacy. 1, 2

Standard Dosing Regimen

• Start with 48 mg daily (24 mg twice daily or 48 mg once daily as modified-release formulation) for maintenance therapy in patients with definite or probable Meniere's disease 1, 2

• Treatment duration must be at least 3 months before evaluating whether the medication is effective 1, 2

• Reassess patients at 6-9 months to determine if continued therapy is warranted 1, 2

• Discontinue betahistine if no improvement occurs after 6-9 months, as continued therapy is unlikely to provide benefit 1, 2

Evidence Quality and Important Caveats

• The American Academy of Otolaryngology-Head and Neck Surgery cannot make a definitive recommendation for betahistine use due to conflicting evidence, particularly the BEMED trial showing no significant difference between betahistine and placebo 2, 3

• Despite this limitation, betahistine remains an option for maintenance therapy to reduce symptoms or prevent Meniere's disease attacks based on observational studies and earlier Cochrane reviews 4

• Higher doses (144 mg/day) showed no advantage over the standard 48 mg/day dose in reducing vertigo attacks, so there is no justification for exceeding the standard dose 1, 2

Modified-Release Formulation

• A 48 mg once-daily modified-release formulation is non-inferior to the traditional 24 mg twice-daily dosing and has a comparable safety profile 1, 5

• The once-daily formulation may improve patient adherence while maintaining equivalent efficacy 5, 6

Absolute Contraindications and Precautions

• Absolutely contraindicated in pheochromocytoma 1, 2, 3

• Use with caution in patients with asthma and peptic ulcer disease 1, 2, 3

• Common side effects include headache, balance disorder, nausea, and upper gastrointestinal symptoms 1, 2, 3

Monitoring Requirements

• No routine laboratory monitoring is required due to betahistine's excellent safety profile over 40 years of clinical use 1, 2

• Monitor clinically for changes in vertigo frequency, tinnitus, hearing loss, and aural fullness 1

• Assess for medication side effects and symptom improvement at regular intervals 3

Clinical Context

• Betahistine is indicated specifically for maintenance therapy, not acute vertigo attacks 1

• Patients must have definite or probable Meniere's disease (≥2 episodes of vertigo lasting 20 minutes to 12 hours with fluctuating sensorineural hearing loss, tinnitus, or aural pressure) 1

• Consider alternative treatments such as intratympanic steroids or gentamicin for patients not responsive to betahistine after adequate trial 4, 2