Intravenous promethazine versus lorazepam for the treatment of peripheral vertigo in the emergency department: A double blind, randomized clinical trial of efficacy and safety

Abstract

Background: Vertigo imposes considerable health restrictions with significant impact on the patient's quality of life. The most effective antivertigo agent is undetermined thus far. Objective: This study was performed to assess whether promethazine has superior vertigo reduction compared with lorazepam in ED patients. Methods: In this randomized, double-blind, parallel group trial 184 patients were assigned (1:1 ratio) to receive either promethazine, 25 mg intravenously, or lorazepam, 2 mg intravenously. Primary endpoint was mean change in vertigo intensity at 2 hours measured using visual analog scale (VAS). Secondary endpoints were mean change in nausea score, need for second dose of study medications, and adverse events (AEs). Results: Promethazine was associated with significantly more reduction (46.5 mm) in vertigo than lorazepam (25.7 mm, p< 0.001). Mean change in nausea score 2 hours after drug injection on the VAS was 28.7 mm for promethazine and 22.8 for lorazepam (p=0.002). The most frequently reported AEs were lethargy (14.1% in lorazepam group, 4.3% in promethazine group, p=0.013) and drowsiness (10.8% for promethazine, 2.1% for lorazepam, p=0.017). Conclusion: Our study demonstrated the evidence that promethazine is superior to lorazepam in management of peripheral vertigo and vertigo-related nausea in ED adults.

Intravenous promethazine vs. diazepam to reduce symptoms of peripheral vertigo in emergency section: a double blind clinical trial

“…The effect of intravenous promethazine (25 mg) and intravenous lorazepam (2 mg) was checked on 184 visitors of the emergency section of Imam Hossein University affiliated with Shahid Beheshti University. This research showed that the former medicine was more effective in treating acute peripheral vertigo than the latter [21]. The overall findings revealed that promethazine was more effective in treating acute peripheral vertigo than benzodiazepines.…”

“…Group A received a treatment with intravenous promethazine (10 mg) made by Caspian Company. The checklist consisted of demographic information, history of disease, severity of vertigo upon admission to emergency section, symptoms upon admission, patient's full examinations, response to treatment, reduction of the severity of symptoms, side effects of treatment and treatment courses [21]. It is noteworthy that 50 mg of promethazine and 10 mg of diazepam are each equal to 1 cc, as used in this study [22].…”

“…The patients were examined 30 minutes, 2 hours and 4 hours after the treatment. The criterion for effectiveness of treatment was 50% of rescued qualitative and quantitative symptoms [21]. Patient information as well as the symptoms were recorded in special forms upon admission to emergency section as well as in the course of treatment measurements.…”

Acute Vestibular Syndrome

“…53 There are few high-grade clinical trials of pharmacologic treatments of vertigo in acute presentations. [54][55][56][57][58] Available studies focus on heterogenous vertigo populations or acute peripheral vertigo presentations without other criteria to make it more specific to certain entitles. The studies are also limited by their outcome measures, which were typically 10-point severity scales obtained 30 minutes to 2 hours after treatment.…”

Seven principles in the treatment of vestibular vertigo and results of the study of VIRTUOSO

“…Бензодиазепины длительного действия, например феназепам, при ВГ не эффективны [4]. Недавно проведенное сравнительное исследование эффективности лоразепама и прометазина продемонстрировало большую эффективность последнего в качестве препарата для купирования ВГ [5].…”