Key points Ask Are benzodiazepines or antihistamines more effective in the treatment of acute vertigo? Findings In this systematic review and meta-analysis of 17 trials with 1586 participants, 7 studies with 802 patients in total evaluated the primary outcome of change in 100-point vertigo visual analogue scale scores approximately 2 hours after treatment with an antihistamine or a benzodiazepine. Antihistamines resulted in greater patient improvement than benzodiazepines (difference, 16.1), but were not superior to other active comparators, such as ondansetron, droperidol, metoclopramide, and piracetam. Meaning The findings of this study suggest that antihistamines may be superior to benzodiazepines in the treatment of acute vertigo and that the use of the latter should be discouraged. |
Summary
Importance
Acute vertigo can be disabling. Antihistamines and benzodiazepines are frequently prescribed as "vestibular suppressants," but their effectiveness is unclear.
Aim
To evaluate the effectiveness of antihistamines and benzodiazepines in the treatment of acute vertigo due to any underlying cause.
Data sources
The PubMed, CENTRAL, EMBASE, CINAHL, Scopus, and ClinicalTrials.gov databases were searched from inception to January 14, 2019, without language restrictions. Bibliographies of included studies and relevant reviews were also reviewed.
Study selection
We included randomized clinical trials (RCTs) that compared the use of antihistamines or benzodiazepines with another comparator, placebo, or no intervention for patients with a duration of acute vertigo of 2 weeks or less. Studies of healthy volunteers, prophylactic treatment or induced vertigo, as well as studies comparing 2 medications of the same class were excluded .
Data extraction and synthesis
Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines , 2 authors extracted data and assessed risk of bias independently for each study. Data were pooled using a random effects model.
Main results and measures
The predefined primary outcome was the change in vertigo or dizziness visual analog scale (VAS) scores of 10 or 100 points at 2 hours after treatment. Secondary outcomes included changes 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.
Results
Of 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 greater improvement in 100-point VAS scores compared with benzodiazepines (difference, 16.1 [95% CI]. %, 7.2 to 25.0]), but did not compare with other active comparators (difference, 2.7 [95% CI, –6.1 to 11.5]).
At one week and one month, neither benzodiazepines nor daily antihistamines were superior to placebo.
RCTs that compared immediate drug effects (at 2 hours) after a single dose generally had a low risk of bias, but those that evaluated outcomes at 1 week and 1 month had a high risk of bias.
Conclusions and relevance
Moderately strong evidence suggests that single-dose antihistamines provide greater relief from vertigo at 2 hours than single-dose benzodiazepines. Furthermore, the available evidence did not support an association of benzodiazepine use with improvement in acute vertigo outcomes. Other evidence suggested that daily use of antihistamines may not benefit patients with acute vertigo.
Larger randomized trials comparing antihistamines and benzodiazepines with placebo could better clarify the relative effectiveness of these medications.
