Histamine Analogue — Vertigo / Ménière's Disease Pregnancy: Avoid — insufficient data; not recommended

Betahistine

Brand names: Serc

Adult dose

Dose: 8–16 mg three times daily with food

Route: Oral

Frequency: Three times daily

Max: 48 mg/day

Treatment for vestibular disorders — Ménière's disease, vertigo of vestibular origin. Partial histamine H1 agonist and H3 antagonist — improves microcirculation in inner ear and reduces endolymphatic hydrops. Long-term treatment needed (6–12 months minimum).

Paediatric dose

Route:

Seek specialist opinion — not licensed in children under 18 years.

Dose adjustments

Renal

No dose adjustment required.

Hepatic

No specific adjustment.

Clinical pearls

Cochrane review: modest evidence for betahistine reducing frequency of vertigo attacks in Ménière's disease — limited RCT quality but widely used in UK practice
BEMED and INVEST trials showed betahistine superior to placebo in reducing vertigo attacks at higher doses (2 × 48 mg/day)
Take with food to reduce GI side effects — common cause of discontinuation

Contraindications

Phaeochromocytoma (histamine stimulates catecholamine release)
Peptic ulcer (histamine H1 effects on gastric acid)

Side effects

GI upset (nausea, dyspepsia — take with food)
Headache
Flushing (histaminergic)
Pruritus (rare)
Hypersensitivity (including bronchospasm in asthma)

Interactions

Antihistamines (pharmacological antagonism — avoid concurrent use)
MAOIs (avoid)

Monitoring

Vertigo attack frequency and severity (patient diary)
Tinnitus and hearing assessment
Clinical response at 3 months — if no benefit, review diagnosis

Reference: BNFc; BNF 90; NICE CKS Ménière's Disease; Cochrane Review (Betahistine for Ménière's disease 2016). Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways