chronic

Meniere's Disease

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources2 sources

Betahistine Dihydrochloride 16mg Tablets SmPC sections 4.1, 4.2, 4.3 and 4.4 (eMC product 13508) · SmPC sections 4.1 and 4.2, https://www.medicines.org.uk/emc/product/1172/smpc

Verified against2 documents

SmPC sections 4.1 and 4.2, https://www.medicines.org.uk/emc/product/1172/smpc
Meniere Disease - disease-level clinical article (menieres-disease-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (6)

Two or more spontaneous vertigo attacks lasting 20 minutes to 12 hours [vertigo]
Fluctuating hearing loss, tinnitus, or a sense of ear fullness in the affected ear [hearing loss · tinnitus]
A low-pitched, roaring quality of tinnitus is typical [tinnitus]
Sudden drop attacks with no loss of consciousness (Tumarkin crises) are highly specific [drop attacks]
Symptom-free intervals occur between attacks
Attacks can be triggered by dietary salt, caffeine, alcohol, stress, fatigue, or emotional upset [fatigue]

Signs — what you find (4)

Interictal exam is usually normal, occasionally with mild spontaneous nystagmus [nystagmus]
Corrective saccades on head-impulse testing of the affected ear can appear between attacks
Horizontal or rotatory spontaneous nystagmus during an attack, unidirectional in 94.3% of cases [nystagmus]
During an attack the patient looks acutely unwell, with vomiting, sweating, and an unsteady gait [sweating · vomiting]

Tests (6)

Audiometry shows low- to mid-frequency sensorineural hearing loss early, later flattening across all frequencies
Routine vestibular function testing or electronystagmography is not recommended to make the diagnosis
Cervical VEMP is abnormal in roughly 76% of definite cases, ocular VEMP in roughly 70%
Contrast brain MRI is obtained to exclude mimics such as a retrocochlear lesion or vestibular neuritis
Delayed gadolinium MRI can show endolymphatic hydrops directly but is only about 26% sensitive early on
Labs such as CBC, ESR, thyroid tests, lipids, glucose, HbA1c, and syphilis serology mainly exclude mimics rather than confirm the diagnosis

If not this — what else fits (10)

Vestibular migraine mimics closely but hearing loss stays mild, symmetric and stable, with migraine features present in half or more of episodes
Positional vertigo under a minute without hearing change points to benign paroxysmal positional vertigo instead
Sustained vertigo over days to weeks after a viral illness, with permanent hearing loss, suggests neuritis or labyrinthitis rather than episodic attacks
Steady, progressive, asymmetric hearing loss with poor speech discrimination points to a vestibular schwannoma rather than episodic disease
Rapidly progressive, usually two-sided hearing loss that improves on steroids points away from Ménière disease
Vertigo brought on by loud noise or straining, rather than spontaneous attacks, suggests superior canal dehiscence
Direction-changing or vertical nystagmus, skew deviation, or new gait imbalance point to posterior circulation stroke instead
Additional neurologic deficits and an inability to walk without falling suggest a cerebellar bleed or mass rather than Ménière disease
Non-spinning dizziness lasting beyond 3 months, worse when upright, moving, or in busy visual settings, suggests a persistent functional vestibular disorder
Vertigo brought on by straining or pressure change after ear surgery or head trauma suggests a perilymphatic fistula

SourceStatPearls "Meniere Disease" - disease-level clinical article

Presentation findings are traced to the source above.

BETAHISTINE

1st line

Strength16 mg

Formoral.solid

Adult dose and duration

Initial 16 mg PO TID with meals; maintenance 24-48 mg daily. - Long term, reviewed for benefit

Paediatric dose

Not recommended in children under 18 years due to insufficient safety/efficacy data.

Dose source

SmPC sections 4.1 and 4.2, https://www.medicines.org.uk/emc/product/1172/smpc

Why

The label indicates betahistine for the vertigo, tinnitus and hearing loss of Meniere's syndrome. It is the only one of those three symptoms most drugs touch, which is why it is the drug named for this disease rather than a general vestibular sedative.

Cautions

CONTRAINDICATED in phaeochromocytoma (product label section 4.3).
Caution with a history of peptic ulcer.
A few asthmatic patients do not tolerate it and need careful monitoring.
Not for BPPV or vestibular neuritis - those are the Peripheral vertigo entry, and betahistine is not indicated for them.
The label expresses the starting dose as two tablets three times daily in the 8 mg presentation, which is the same 16 mg three times daily.
No dose change is needed in the elderly or in renal or hepatic impairment, per the label.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
VERTISERC 16MG 10 TAB.	AMOUN	5.00 EGP (0.50/unit)
HISTINE 16MG 20 TAB.	HIKMA PHARMA > FUTURE PHARMACEUTICAL INDUSTRIES (FPI)	14.00 EGP (0.70/unit)
BALANSERC 16 MG 20 TABS.	FUTURE PHARMACEUTICAL INDUSTRIES (FPI) > SUN PHARMA EGYPT LIMITED	22.00 EGP (1.10/unit)
MEPAHIST 16 MG 20 TAB.	MEPACO	22.00 EGP (1.10/unit)
STEADYFUTAL 16 MG 60 TAB.	FUTURE PHARMACEUTICAL INDUSTRIES (FPI)	132.00 EGP (2.20/unit)
MICROSERC 16 MG 20 TAB.	AMRIYA	46.00 EGP (2.30/unit)
VERSERC 16MG 30 TAB.	CHEMIPHARM	87.00 EGP (2.90/unit)
BETASERC 16 MG 60 TABS.	ABBOTT LABORATORIES	219.00 EGP (3.65/unit)

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line

Dose source

Meniere Disease - disease-level clinical article (menieres-disease-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions

RED FLAG - Urgent evaluation is needed to exclude potentially life-threatening cannot-miss diagnoses (posterior circulation stroke/TIA, cerebellar hemorrhage or tumor) in suspected Meniere presentations.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.