1. Introduction
Betahistine, commonly marketed under brand names such as Serc, Betaserc, and Vertin, is a histamine analogue primarily used to treat balance disorders such as Ménière’s disease and vertigo. It acts by improving blood flow in the inner ear and reducing pressure, thus alleviating symptoms like dizziness, tinnitus, and hearing loss.
2. Indications
- Approved Indications:
- Ménière’s disease (characterised by vertigo, tinnitus, and hearing loss).
- Vestibular vertigo.
- Off-Label Uses:
- Persistent postural-perceptual dizziness (PPPD).
3. Dosage
- Adults:
- Initial dose: 8–16 mg three times daily.
- Maintenance dose: 24–48 mg daily in divided doses.
- Maximum Dose: 48 mg per day.
4. Administration
- Take orally, preferably with or after food to reduce gastrointestinal discomfort.
- Tablets should be swallowed whole with water; do not crush or chew.
5. Forms Available
- Tablets: 8 mg, 16 mg, 24 mg.
6. Side Effects
6.1. Common Side Effects
- Nausea.
- Dyspepsia.
- Headache.
6.2. Less Common Side Effects
- Bloating or abdominal discomfort.
- Skin rash.
6.3. Rare but Serious Side Effects
- Hypersensitivity reactions (e.g., angioedema, urticaria).
7. Warnings
- Contraindicated in patients with a history of pheochromocytoma due to its histamine-related effects.
- Caution in patients with peptic ulcer disease or a history of gastrointestinal bleeding.
8. Precautions
- Use with caution in patients with bronchial asthma, as betahistine may exacerbate symptoms.
- Patients should avoid sudden discontinuation to prevent recurrence of symptoms.
9. Interactions
- Drug-Drug Interactions:
- Antihistamines: May reduce the effectiveness of betahistine.
- Monoamine oxidase inhibitors (MAOIs): Increased risk of side effects due to elevated betahistine levels.
- Drug-Food Interactions:
- No significant food interactions.
10. Monitoring Parameters
- Symptom relief within a few weeks of initiation.
- Watch for signs of gastrointestinal irritation.
- Monitor patients with asthma or a history of gastric ulcers closely.
11. Use in Children
- Safety and efficacy have not been established in children; not recommended.
12. Use in Pregnancy
- Limited data available.
- Use only if the potential benefit outweighs the risk to the foetus.
13. Use in Elderly
- No specific dosage adjustments required.
- Monitor for gastrointestinal side effects and other comorbid conditions.
14. Use in Kidney Disease
- Use with caution in patients with severe renal impairment, as no specific studies are available.
15. Use in Liver Disease
- Use with caution in severe hepatic impairment due to limited data on metabolism.
16. Patient Counselling Points
- Inform patients that betahistine works gradually and full benefits may take weeks to manifest.
- Advise taking the medication with food to minimise nausea or dyspepsia.
- Highlight the importance of adhering to the prescribed regimen and avoiding dose skipping.
- Inform patients about possible side effects such as headache or mild stomach upset.
- Advise reporting any signs of allergic reactions, such as rash or swelling, immediately.
17. Table of Brand Names, Manufacturers, and Prices
Brand Name | Manufacturer | Price (USD) |
---|---|---|
Serc | Abbott | $15 (30 tablets, 16 mg) |
Betaserc | Mylan | $12 (30 tablets, 16 mg) |
Vertin | Dr. Reddy’s | $10 (30 tablets, 16 mg) |
Generic Options | Various | $5–8 (30 tablets, 16 mg) |
18. FAQs (15 Questions)
- What is betahistine used for?
Betahistine is used to treat Ménière’s disease and vertigo by improving blood flow in the inner ear. - How does betahistine work?
It acts as a histamine analogue, increasing blood flow and reducing pressure in the inner ear. - Can betahistine be taken with food?
Yes, it is best taken with or after food to minimise stomach upset. - What are the common side effects of betahistine?
Nausea, dyspepsia, and headache are common side effects. - Is betahistine safe for children?
No, it is not recommended for children as safety and efficacy are not established. - Can pregnant women take betahistine?
Use only if the potential benefit outweighs the risks; consult a healthcare provider. - How long does it take for betahistine to work?
It may take a few weeks to see the full benefits of the medication. - What should I do if I miss a dose?
Take the missed dose as soon as you remember unless it’s close to the next dose. Do not double up. - Can I stop taking betahistine once I feel better?
No, continue the medication as prescribed to prevent symptom recurrence. - Does betahistine interact with antihistamines?
Yes, antihistamines may reduce its effectiveness. - Can betahistine cause allergic reactions?
Rarely, it can cause hypersensitivity reactions like rash or swelling. - Is betahistine effective for tinnitus?
Yes, it may help reduce tinnitus associated with Ménière’s disease. - How should betahistine be stored?
Store at room temperature, away from moisture and heat. - Can betahistine cause weight gain?
No, weight gain is not a reported side effect. - Do I need regular tests while on betahistine?
Generally, no regular tests are required, but symptom monitoring is essential.