Comparison of the therapeutic efficacy of intravenous dimenhydrinate and intravenous piracetam in patients with vertigo: a randomised clinical trial

Doğan, Nurettın Özgür; Avcu, Nazire; Yaka, Elif; Yılmaz, Serkan; Pekdemir, Murat

doi:10.1136/emermed-2014-204006

Cited by 7 publications

(9 citation statements)

References 18 publications

(22 reference statements)

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“…Figure 2 illustrates the ROB for individual studies, which ranged from low to high. Among the 8 trials that evaluated 2-hour outcomes, 5 trials had low ROB, including all 3 trials that compared benzodiazepines with antihistamines. One trial had a high ROB for blinding but low risk in all other domains, and the other had unclear ROB in all domains except blinding.…”

Section: Resultsmentioning

confidence: 99%

“…Seventeen studies [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] with a total of 1586 participants contributed to the quantitative results (Table 2). These studies spanned 11 countries and 6 languages and each enrolled between 18 and 200 patients.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…21,29,35 Four studies 26,28,36,37 Epley repositioning maneuvers alone vs Epley maneuvers in combination with antihistamines. In 8 studies, 21,24,25,27,29,31,34 medications were given as a single dose, and results were provided on immediate outcomes at 30 minutes to 2 hours. In the remaining 9 studies, 22,23,26,28,30,32,33,[35][36][37] medications were given enterally for 1 week to 2 months.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…For the primary outcome, 7 trials 21,24,25,27,29,34,35 encompassing 802 patients contributed data for meta-analysis (Figure 3).…”

Section: Quality Assessmentmentioning

confidence: 99%

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Efficacy of Benzodiazepines or Antihistamines for Patients With Acute Vertigo

et al. 2022

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IMPORTANCE Acute vertigo can be disabling. Antihistamines and benzodiazepines are frequently prescribed as "vestibular suppressants," but their efficacy is unclear.OBJECTIVE To assess the efficacy of antihistamines and benzodiazepines in the treatment of acute vertigo from any underlying cause.DATA SOURCES We searched the PubMed, CENTRAL, EMBASE, CINAHL, Scopus, and ClinicalTrials.gov databases from inception to January 14, 2019, without language restrictions. Bibliographies of the included studies and relevant reviews were also screened. STUDY SELECTIONWe included randomized clinical trials (RCTs) comparing antihistamine or benzodiazepine use with another comparator, placebo, or no intervention for patients with a duration of acute vertigo for 2 weeks or less. Studies of healthy volunteers, prophylactic treatment, or induced vertigo were excluded, as were studies that compared 2 medications from the same class. DATA EXTRACTION AND SYNTHESIS Following Preferred Reporting Items for SystematicReviews and Meta-analyses (PRISMA) guidelines, data were extracted and risk of bias was assessed by 2 authors independently for each study. Data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURESThe predefined primary outcome was change in 10-or 100-point vertigo or dizziness visual analog scale (VAS) scores at 2 hours after treatment. Secondary outcomes included change in nausea VAS scores at 2 hours, use of rescue medication at 2 hours, and improvement or resolution of vertigo at 1 week or 1 month. RESULTSOf the 27 trials identified in the systematic review, 17 contributed to the quantitative meta-analysis and involved a total of 1586 participants. Seven trials with a total of 802 participants evaluated the primary outcome of interest: single-dose antihistamines resulted in significantly more improvement on 100-point VAS scores compared with benzodiazepines (difference, 16.1 [95% CI, 7.2 to 25.0]) but not compared with other active comparators (difference, 2.7 [95% CI, -6.1 to 11.5]). At 1 week and 1 month, neither daily benzodiazepines nor antihistamines were reported to be superior to placebo. RCTs comparing the immediate effects of medications (at 2 hours) after a single dose generally had a low risk of bias, but those evaluating 1-week and 1-month outcomes had a high risk of bias. CONCLUSIONS AND RELEVANCEModerately strong evidence suggests that single-dose antihistamines provide greater vertigo relief at 2 hours than single-dose benzodiazepines. Furthermore, the available evidence did not support an association of benzodiazepine use with improvement in any outcomes for acute vertigo. Other evidence suggested that daily antihistamine use may not benefit patients with acute vertigo. Larger randomized trials comparing both antihistamines and benzodiazepines with placebo could better clarify the relative efficacy of these medications.

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Section: Resultsmentioning

confidence: 99%

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…For the primary outcome, 7 trials 21,24,25,27,29,34,35 encompassing 802 patients contributed data for meta-analysis (Figure 3).…”

Section: Quality Assessmentmentioning

confidence: 99%

See 2 more Smart Citations

Efficacy of Benzodiazepines or Antihistamines for Patients With Acute Vertigo

et al. 2022

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“…They can be used in acute vertigo, for the relief of nausea and vomiting, 7 after repositioning maneuvers and in the treatment of kinetosis. The most commonly used medications are dimenhydrinate, 8 meclizine 9 and promethazine. 10 …”

Section: Resultsmentioning

confidence: 99%