Betahistine Dosing Frequency
Betahistine should be taken three times per day (TID), with a standard maintenance dose of 16 mg three times daily (total 48 mg/day) for vestibular disorders. 1, 2
Standard Dosing Regimen
The recommended dosing is 16 mg three times per day (TID), which totals 48 mg daily for maintenance therapy in Ménière's disease and peripheral vestibular vertigo 1, 2, 3
Treatment should be continued for at least 3 months to properly evaluate efficacy, with reassessment at 6-9 months 1, 2
The medication can be taken with meals to minimize gastrointestinal side effects such as nausea and upper GI symptoms 2
Alternative Dosing Schedules
In the research setting, betahistine has been administered twice daily (BID) at 16 mg per dose in some clinical trials, though this is not the guideline-recommended frequency 3
Low-dose regimens of 6 mg three times daily have been studied for residual dizziness after BPPV treatment, showing efficacy when combined with cognitive behavioral therapy 4
High-dose regimens ranging from 288-480 mg/day (divided into multiple doses throughout the day) have been used in severe, refractory Ménière's disease cases that failed standard 48 mg/day dosing, though this remains off-guideline 5
Clinical Considerations
The three-times-daily schedule maintains more consistent drug levels throughout the day, which may be important given betahistine's mechanism as a histamine H1 agonist and H3 antagonist affecting inner ear vasodilation 2
If no improvement occurs after 6-9 months of treatment, continued betahistine therapy is unlikely to provide benefit and should be discontinued 1, 2
Common side effects including headache, balance disorder, nausea, and upper GI symptoms may be dose-related and can improve with dose adjustment or taking medication with food 2, 6