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Efficacy of Benzodiazepines or Antihistamines for Patients With Acute Vertigo: A Systematic Review and Meta-analysis | Vestibular Disorders | JAMA Neurology











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Original Investigation

July 18, 2022


Benton R.  Hunter, MD1; Alfred Z. Wang, MD1; Antonino W. Bucca, MD1,2; et al
Paul I. Musey Jr, MD1; Christian C. Strachan, MD1; Steven K. Roumpf, MD1; Steven L. Propst, MD1,3; Alexander Croft, MD1; Laura M. Menard, MIS4; Jonathan M. Kirschner, MD1

Author AffiliationsArticle Information

  • 1Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis

  • 2Department of Emergency Medicine, Parma Medical Center, University Hospitals, Parma, Ohio

  • 3Department of Emergency Medicine, University of Missouri, Springfield

  • 4Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis


JAMA Neurol. 2022;79(9):846-855. doi:10.1001/jamaneurol.2022.1858

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Key Points

Question 
Are benzodiazepines or antihistamines effective in the treatment of acute vertigo?

Findings 
In this systematic review and meta-analysis of 17 trials involving 1586 participants, 7 studies comprising 802 total patients evaluated the primary outcome of change in 100-point vertigo visual analog scale scores at approximately 2 hours after treatment with an antihistamine or benzodiazepine. Antihistamines resulted in greater patient improvement than benzodiazepines (difference, 16.1) but were not superior to other active comparators, including 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.


Abstract

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 Selection 
We 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 Systematic Reviews 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 Measures 
The 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.

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 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 Relevance 
Moderately 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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Treatment Options for Dizziness | San Francisco Audiology



Posted on by San Francisco Audiology

There are many possible causes for dizziness and vertigo symptoms, including:

  • Benign paroxysmal positional vertigo (BPPV)
  • Meniere’s disease
  • Ear infection
  • Multiple sclerosis
  • Concussion
  • Alcohol
  • Medication toxicity
  • Stroke
  • Viral meningitis

Once your doctor has determined the underlying cause of your dizziness/vertigo, you can begin treatment. Below are some of the most common dizziness treatments.

Vestibular Rehabilitation Therapy

Vestibular rehabilitation therapy (VRT) is an effective method for reducing dizziness and vertigo. During this treatment, you’ll work with a physical therapist who will create an exercise-based program focused on improving balance, reducing dizziness and overcoming vertigo.

Epley Maneuver

The Epley maneuver is effective for treating BPPV, a condition that causes dizziness due to calcium crystals becoming dislodged in the inner ear. During this treatment, your doctor will walk you through a series of body movements designed to move the crystals to a less sensitive area where they can be reabsorbed by the body.

Dietary Changes

Studies have shown that sodium, caffeine and alcohol intake can affect your balance. In fact, many have turned to a low-sodium diet to prevent dizziness caused by Meniere’s disease, a condition that causes episodes of hearing loss, dizziness and tinnitus. If you are experiencing dizziness, try to limit your intake of these substances.

Antihistamines

Allergic episodes cause many symptoms, including nausea, vomiting, dizziness and diarrhea, among others. If your dizziness is allergy-related, an antihistamine such as Benadryl may help.

Migraine Medications

One study published in 2018 in Otology & Neurotology found that medications that prevent migraines, including tricyclic antidepressants, can be effective in decreasing dizziness and vertigo.

Sedatives

Extreme anxiety can cause people to feel symptoms of dizziness and vertigo. According to the American College of Cardiology, sedatives such as Valium, Ativan and Xanax can reduce these symptoms by calming brain activity, thus reducing anxiety and related issues.

Diuretics

If you have Meniere’s disease, diuretics (also called water pills) may prevent buildup of endolymph fluid in the inner ear, which can cause dizziness.

Drink More Water

Dehydration is a major cause of dizziness, according to the Mayo Clinic. To prevent episodes of dizziness, drink at least 64 ounces of water a day, and try to avoid dehydrating substances like alcohol, salty foods and caffeine.

For more information or to talk to a doctor about treating your symptoms of dizziness and vertigo, call the experts at San Francisco Audiology today.

Learn More About Ear Disorders

  • Understanding the Vestibular System
  • What is An Acoustic Neuroma?


Can Benadryl help with vestibular disorders in dogs?

Symptoms of dizziness and nausea can be reduced with dizziness medicines such as meclizine (Antivert) and diphenhydramine (Benadryl). Never give medication without first consulting your veterinarian.

In the case of idiopathic vestibular syndrome, treatment includes supportive care until the symptoms resolve on their own. Dizziness medications such as meclizine are often prescribed along with anti-nausea medications.

Treatment of vestibular syndrome often includes supportive care such as intravenous fluids and nutrition. Hospitalization may also be required until the pet can eat and walk on its own. If your dog is severely disoriented or tripping, they may be given a sedative.

Help them get comfortable – if your dog is having trouble sleeping, try placing a rolled blanket or towel under his head for support. Spend time with them on the floor while their world is turned upside down.

“There is no reason to suppress them. We don’t often see brain damage in dogs. A severely prolonged seizure can be detrimental, but do not rush to euthanize, even in the event of a seizure,” she emphasizes. Of course, sudden dizziness in dogs can look like a seizure; they are often difficult to distinguish.

While these signs can be scary, the good news is that most dogs recover from vestibular disease. Although some can keep their head tilted, they seem to regain their sense of balance and feel great. Like humans, dogs can have strokes, but they are usually not as common as in humans.

Vestibular dysfunction is most often caused by head trauma, aging and viral infection. Other medical conditions, as well as genetic and environmental factors, can also cause or contribute to vestibular disorders. Balance imbalance: unsteadiness, imbalance or loss of balance; often accompanied by spatial disorientation.

Depending on the severity and location of the vestibular disease, many but not all dogs will also be reluctant or unable to stand or walk and may have difficulty doing so, which can be quite frustrating for the dog, but also for you, the owner. Most dogs lean or fall in the direction of head tilt.

Dimenhydrinate (brand names: Dramamine®, Gravol®, Travtabs®, Driminate®, Triptone®) is an antihistamine used to prevent motion sickness and treat nausea, especially in dogs with vestibular disorders. It is also used for its sedative properties and reduction of itching associated with allergies.

This is a nervous disorder that causes the dog to become very dizzy and unbalanced. One way to tell if a dog’s eyes are moving back and forth. This is traumatic for the animal because it obviously doesn’t know what’s going on and it can make the old dog’s condition worse.

Although not the most fancy name for the disease, vestibular disease in old dogs looks like a stroke. In fact, this is an acute inflammation of the vestibular nerve. This nerve passes through the inner/middle ear and exits the brain and its purpose is to help all of us stay physically balanced.

Affected dogs receive erroneous signals to the brain from inner ear sensors that insist they are falling when they are not. Tilting the head so that one ear is up and the other is down seems to help satisfy the erroneous sensors and partially reduce the feeling of falling.

Although idiopathic vestibular disease may recur in dogs after initial improvement, it is less common than with stroke, and the interval between episodes is usually longer with idiopathic vestibular disease (months or more) than with stroke (days to weeks or more) .

Benadryl vs Claritin: Differences, Similarities and Which is Best for You – Health Education

Home >> Health Education >> Benadryl vs Claritin: Differences, Similarities and Which is Best for You

Health education

Drug overview and main differences | Conditions of treatment | Efficiency | Insurance coverage and cost comparison | Side effects | Drug Interactions | Warnings | Frequently Asked Questions

Depending on where you live, allergy season is already here, if not soon. Some people are not bothered by seasonal allergies. For others, seasonal and year-round allergies may warrant antihistamines. Although there are many treatment options, it is important to know the difference between them.

Benadryl (diphenhydramine) and claritin (loratadine) are two common OTC drugs that can treat allergy symptoms. When you come into contact with allergens such as dust mites, pet dander, or pollen, your body releases a chemical called histamine. This chemical causes sneezing, runny nose, itching, and watery eyes. Antihistamines work by blocking histamine to treat and prevent these symptoms.

Benadryl and Claritin may work in a similar way, but they are different types of drugs. We will compare these drugs and discuss their differences in action, cost, and side effects.

RELATED: Diphenhydramine Coupons | What is diphenhydramine? | Coupons for loratadine | What is loratadine?

What are the main differences between Benadryl and Claritin?

The biggest difference between Benadryl and Claritin is that Benadryl causes more sleepiness than Claritin. Benadryl, also known by the generic name diphenhydramine, is known as a first generation antihistamine. This group of antihistamines is among the first drugs developed to treat allergy symptoms.

Claritin, also known collectively as loratadine, is classified as a second-generation antihistamine. In other words, Claritin is part of a group of new antihistamines. Second-generation antihistamines were developed to treat allergy symptoms without causing as much sleepiness as first-generation antihistamines.

Claritin tablets are taken once a day, while Benadryl must be taken several times a day. This is because Claritin stays in the body longer than Benadryl.

900 65

Main differences between Benadryl and Claritin
Benadryl Claritin 90 050
Drug class Antihistamine
First generation
Antihistamine
Second generation
Brand / generic status Brand and generic versions available Brand and generic versions available
What is the common name? Diphenhydramine Loratadine
What form(s) does the drug come in? Oral Capsule
Oral Tablet
Oral Solution
Oral Syrup
Oral Capsule
Oral Tablet
Oral Solution
Oral Syrup
What is the standard dosage? 25 to 50 mg every 4-6 hours 10 mg once daily
How long does a typical treatment last? Short-term use Short-term or long-term use as prescribed by a physician
Who usually takes this medicine? Adults and children over 2 years old Adults and children over 2 years old

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Conditions treated with Benadryl and Claritin

Benadryl and Claritin are FDA approved for the treatment of allergy symptoms.

Both allergy medicines can treat allergic rhinitis, also known as hay fever. Allergic rhinitis is a group of symptoms that affect the nose, such as nasal congestion and sneezing. Both drugs can treat allergic conjunctivitis, which leads to inflammation and itching in the eyes. Antihistamines like Benadryl or Claritin can also treat skin urticaria (urticaria) and itching (itching) from allergies.

Because Benadryl has sedative properties, it is often used alone or in combination with other insomnia medications. It is sometimes taken as a single dose to help those who have trouble sleeping.

Benadryl may also be used to treat symptoms of Parkinson’s disease such as stiffness and tremors. For those who experience motion sickness, Benadryl can be used to prevent nausea, vomiting, and dizziness.

Condition Benadryl Claritin
Allergic rhinitis yes 900 75

yes
Allergic conjunctivitis yes yes
Urticaria yes
Itching yes yes
Insomnia yes No
Seasickness yes no 46

Are Benadryl or Claritin more effective?

While Benadryl and Claritin are equally effective for treating allergy symptoms, Claritin has fewer sedative side effects. For this reason, Claritin is often preferred over Benadryl.

Based on guidelines developed by the American Academy of Otolaryngology – Head and Neck Surgery and approved by the American Academy of Family Physicians (AAFP), second-generation antihistamines are recommended for the treatment of symptoms of allergic rhinitis such as sneezing and itching.

Other recommendations from the American Academy of Allergy, Asthma, and Immunology (AAAAI) suggest using a nasal steroid such as Flonaz or Nasacort for allergic rhinitis before adding an oral antihistamine.

Literature review studies have found that newer antihistamines such as loratadine are safer than first-generation antihistamines. The study also compared other second-generation antihistamines such as Zyrtec (cetirizine) and Allegra (fexofenadine). The study showed that cetirizine or fexofenadine may be more effective than loratadine.

The choice of antihistamine depends on your general condition. Talk to your doctor or pharmacist to determine which treatment option is right for you.

RELATED: What is Zyrtec? | What is Allegra?

Get a SingleCare Prescription Discount Card

Benadryl vs Claritin Coverage and Cost Comparison

Benadryl is available without a prescription. For this reason, most Medicare programs and insurance plans may not cover Benadryl. Benadryl is widely available in the form of diphenhydramine. Many pharmacies, grocery stores, and large retailers also sell diphenhydramine in their own store. The cost of Benadryl can reach $18. If your doctor has prescribed you, Benadryl (Benadryl Coupon) can cost less than $2 with a SingleCare Coupon.

Claritin (claritin coupon) is supplied in boxes of 5 to 100 tablets. It is sold over-the-counter as the brand name Claritin or generic loratadine. Most Medicare programs and insurance plans may not cover Claritin, so it’s best to check with your insurance. The average retail price of Claritin is about $30. With a prescription, SingleCare costs $4-10.

RELATED: What is Benadryl? | What is Claritin?

90 072 Usually covered by insurance? 90 072 Typical Medicare copay
Benadryl Claritin
No No
Usually covered by Medicare? No No
Standard dosage 25mg tablets (30 pcs) 10mg (30 pcs)
$2 $18-44
SingleCare Cost $1.52 + $4-10

Common side effects of Benadryl and Claritin

Antihistamines can often have side effects affecting the central nervous system (CNS). Common CNS side effects of antihistamines such as Benadryl and Claritin include drowsiness, sedation, dizziness, headache, and incoordination. However, as a first generation antihistamine, Benadryl is known to cause more CNS side effects compared to newer antihistamines.

Other side effects of Benadryl and Claritin include: dry mouth, dry or sore throat, and skin rash. These drugs can also cause digestive side effects such as nausea, diarrhea, and constipation.

Most side effects of antihistamines are mild and tolerable. Side effects depend on how the person responds to the medication and may be different for everyone.

9007 2 *

Benadryl Claritin
Side effect Applicable? Frequency Applicable? Frequency
Sleepiness yes *not reported yes *
Sed yes * yes *
Dizziness yes * yes*
Headache yes* yes*
Lack of coordination yes * yes *
Dry mouth yes * yes *
Sore or dry throat yes * yes
Skin rash yes * yes *
5

*
Constipation yes * yes *

This may not be a complete list of side effects that you may experience. Please contact your doctor or health care provider for more information.

Source: DailyMed (Benadryl), DailyMed (Claritin)

Benadryl and Claritin drug interactions

Antihistamines such as Benadryl and Claritin may interact with other drugs that have similar effects. First and second generation antihistamines should be warned or avoided in conjunction with CNS depressants such as hypnotics, benzodiazepines, barbiturates, anticonvulsants, and muscle relaxants. Opioids also have a CNS depressant effect, which may be exacerbated when combined with antihistamines.

Benadryl or Claritin should not be used if you are taking a monoamine oxidase inhibitor (MAOI) or within 2 weeks of stopping an MAOI. Taking these medicines together may lead to an increased risk of side effects.

The use of anticholinergics with antihistamines may increase the side effects of drying, such as dry mouth or dry throat.

Drug Drug class Benadryl Claritin
Phenelzine
Selegiline
Isocarboxazid
Monoamine oxide inhibitor aza (MAOI) yes yes
Esopiclone
Zaleplon
Zolpidem
Hypnotic yes yes
Alprazolam
Lorazepam
Diazepam
Benzodiazepine yes yes 9 yes yes
Carbamazepine
Gabapentin 9 0075

Anticonvulsant yes yes
Cyclobenzaprine
Carisoprodol
Muscle relaxes yes yes
Codeine Opioids yes yes
Benztropine
Atropine
Oxybutynin
Anticholinergic yes yes

This is not a complete list of drug interactions. Check with your doctor before taking these medicines.

Benadryl and Claritin Warnings

Benadryl or Claritin should not be used if you have had an allergic reaction to any of the active ingredients listed on the package. Taking these medicines may cause a hypersensitivity reaction, such as difficulty breathing or a severe rash, if you are allergic to the medicine.

Because antihistamines can cause increased drowsiness and drowsiness, they should be used with caution when engaging in certain activities such as driving or operating machinery.

Benadryl is not recommended for the elderly 65 years and older. Taking Benadryl may increase the risk of dementia or cognitive impairment, delirium, and fainting.

Talk to your doctor before using Benadryl or Claritin if you have asthma, liver or kidney disease.

Frequently asked questions about Benadryl and Claritin

What is Benadryl?

Benadryl is the brand name for diphenhydramine. It is a first generation antihistamine that can treat allergy symptoms. Benadryl can also be used for insomnia, motion sickness, and parkinsonism. It is usually taken every 4-6 hours.

What is Claritin?

Claritin is the brand name for loratadine HCl. It is a second generation antihistamine that can treat allergy symptoms such as sneezing, runny nose and itchy eyes. Claritin is an over-the-counter drug that is taken once a day.

Are Benadryl and Claritin the same thing?

No. Benadryl and Claritin are not the same thing. Benadryl works differently and has a different side effect profile compared to Claritin. Claritin is a newer drug than Benadryl.

Is Benadryl or Claritin better?

Claritin is usually recommended instead of Benadryl for allergic rhinitis and other allergy symptoms. Both drugs have similar efficacy, but Claritin has fewer sedative side effects. Claritin only needs to be taken once a day, which may be preferable for some people.

Can I use Benadryl or Claritin while pregnant?

Benadryl and Claritin are generally safe to use during pregnancy. According to the CDC, most antihistamines do not cause birth defects. Talk to your doctor before using antihistamines if you are pregnant or planning to become pregnant.

Can I take Benadryl or Claritin with alcohol?

Antihistamines such as Benadryl or Claritin are generally not recommended for use with alcohol. Taking these medicines with alcohol may increase the risk of side effects such as dizziness or drowsiness.

Can I take Claritin and Benadryl? / Can I take Benadryl 12 hours after Claritin?

It is not recommended to take Claritin and Benadryl together. Since they have similar side effects, taking them together may increase the risk of side effects. Claritin has a relatively long half-life, so taking Benadryl 12 hours after Claritin may not be safe. Talk to your doctor before taking multiple antihistamines.

How long does it take for Benadryl to take effect?

Benadryl peaks in the body within 2 hours.

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