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Histamine Analogue — Vestibular Pregnancy: Avoid in pregnancy — limited safety data

Betahistine

Brand names: Serc

Adult dose

Dose: 8-16 mg three times daily
Route: Oral
Frequency: Three times daily with food
Max: 48 mg/day
Take with food to reduce GI side effects. Treatment may take 2-3 months for full effect in Meniere's disease

Paediatric dose

Dose: Seek specialist opinion N/A/kg
Route: Oral
Frequency: Seek specialist opinion
Max: Seek specialist opinion
Seek specialist opinion

Dose adjustments

Renal

No adjustment required

Hepatic

Use with caution in severe hepatic impairment

Paediatric weight-based calculator

Seek specialist opinion

Clinical pearls

  • Licensed for Meniere's disease (vertigo, tinnitus, hearing loss) — efficacy is modest and evidence is mixed; NICE does not strongly endorse but it is widely used in ENT practice
  • Acts as a weak partial agonist at H1 receptors and antagonist at H3 receptors in the inner ear — improves microcirculation and reduces endolymphatic pressure
  • Vestibular neuritis (acute): vestibular suppressants (betahistine, cinnarizine) can mask compensation — physiotherapy-led vestibular rehabilitation is preferred for long-term recovery
  • Well-tolerated in elderly — low anticholinergic burden, no significant CNS effects, no falls risk (advantage over prochlorperazine and cinnarizine)
  • May take 2-3 months for effect in Meniere's — counsel patients on expectations; review at 6 months

Contraindications

  • Phaeochromocytoma (theoretical risk — histamine agonism)
  • Peptic ulcer disease (active)

Side effects

  • Headache (common)
  • Nausea and GI upset (take with food)
  • Pruritus and urticaria (rare hypersensitivity)
  • Rarely bronchoconstriction (use with caution in asthma)

Interactions

  • Antihistamines (theoretical antagonism — avoid combination)
  • MAOIs (theoretical interaction)

Monitoring

  • Symptom response (vertigo frequency, tinnitus, hearing)
  • GI tolerability

Reference: BNFc; BNF 90; NICE Evidence Review (Betahistine for Meniere's); Cochrane Review (betahistine); BSA Meniere's guidance. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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