Histamine Analogue (Vestibular)
Pregnancy: Avoid — limited data
Betahistine
Brand names: Serc
Adult dose
Dose: 8–16 mg TDS (with food). May increase to 24 mg TDS.
Route: Oral
Frequency: TDS
Max: 48 mg/day
For Ménière's disease — reduces frequency and severity of vertigo attacks. Not effective for acute vertigo. Treatment trial of at least 3 months needed to assess response. Take with food.
Paediatric dose
Route: N/A
Frequency: N/A
Max: Not licensed in children
Not established in paediatric patients
Dose adjustments
Renal
No dose adjustment required
Hepatic
No dose adjustment required
Clinical pearls
- Ménière's disease: betahistine reduces endolymphatic pressure and improves cochlear blood flow — reduces vertigo attack frequency (not acute attacks)
- Take with food to reduce GI side effects
- 3–6 month trial required before assessing benefit
- Vestibular sedatives (prochlorperazine/cinnarizine): for acute vertigo episodes; betahistine is long-term prophylactic
Contraindications
- Phaeochromocytoma (theoretical — histamine may precipitate crisis)
- Asthma (relative — can worsen)
Side effects
- Nausea (take with food)
- GI upset
- Headache
- Pruritus and rash (histamine effect)
- Worsening of asthma
Interactions
- Antihistamines — may antagonise betahistine activity
Monitoring
- Vertigo attack frequency and severity
- Audiometry (annual)
- Asthma symptoms
Reference: BNFc; BNF; British Society of Audiology (BSA) Ménière's Guidelines; NICE Evidence. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
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