Vasteral (Betahistine): Uses, Dosage, Side Effects, and Precautions

Betahistine (Vasteral) for Ménière's Disease

Vasteral is a brand name for betahistine dihydrochloride, a histamine analog (H₁-agonist / H₃-antagonist) used to reduce vertigo, tinnitus, and hearing loss associated with Ménière's disease (endolymphatic hydrops).

Mechanism

Improves microcirculation in stria vascularis → reduces endolymphatic pressure.
Modulates vestibular nuclei neurotransmission → reduces vertigo signaling.

Dosage and Administration

Form	Typical Adult Dose	Notes
Tablets (8 mg, 16 mg, 24 mg)	8–16 mg TID (24–48 mg/day); max 48 mg/day	With meals to reduce GI upset. 24 mg SR available (BID).
Injection (solution for IV/IM)	25 mg (1 ampule) daily or BID	Acute severe attacks; hospital setting; not for chronic use.

Dose titration: Start low, increase based on response. Trial ≥4–6 weeks for full effect.

Common Side Effects (≥1%)

GI: Nausea, dyspepsia, abdominal pain, bloating (most common)
Headache
Dizziness (paradoxical)
Skin reactions: rash, pruritus, urticaria

Serious Adverse Effects (Rare)

Bronchospasm (caution in asthma)
Hypersensitivity (angioedema, anaphylaxis)
Seizure threshold lowering (caution in epilepsy)
Cardiac: tachycardia, palpitations

Contraindications & Precautions

Contraindicated: Pheochromocytoma (catecholamine release risk), hypersensitivity.
Caution: Peptic ulcer disease (↑ gastric acid), asthma, hypotension, renal/hepatic impairment, pregnancy/lactation (insufficient data—avoid unless benefit > risk).
Drug Interactions: Antihistamines (H₁ blockers) may reduce efficacy; MAOIs (theoretical); beta-agonists.

Monitoring

Symptom diary (vertigo frequency/severity, tinnitus, hearing).
Periodic audiometry.
Assess GI tolerance; take with food.

Betahistine is generally well-tolerated. If ineffective after 3 months, reassess diagnosis and consider alternatives (diuretics, vestibular rehab, intratympanic gentamicin, surgery).