How do antihistamines and benzodiazepines compare in treating acute vertigo. What are the key findings of the systematic review and meta-analysis on vertigo treatments. Which medications show the most promise for alleviating vertigo symptoms.

Understanding Acute Vertigo and Common Treatments

Acute vertigo is a debilitating condition characterized by a sensation of spinning or dizziness. It can significantly impact a person’s quality of life and daily functioning. While various treatment options exist, antihistamines and benzodiazepines are frequently prescribed as “vestibular suppressants” to alleviate vertigo symptoms. However, the efficacy of these medications has been a subject of debate in the medical community.

A comprehensive systematic review and meta-analysis published in JAMA Neurology aimed to shed light on the effectiveness of antihistamines and benzodiazepines in treating acute vertigo. The study, conducted by Benton R. Hunter, MD, and colleagues, analyzed data from multiple randomized clinical trials (RCTs) to provide evidence-based insights into the most effective treatment options.

Methodology of the Systematic Review and Meta-analysis

The researchers employed a rigorous methodology to ensure the validity and reliability of their findings. Here are the key aspects of their approach:

• Database search: PubMed, CENTRAL, EMBASE, CINAHL, Scopus, and ClinicalTrials.gov were searched from inception to January 14, 2019.
• Inclusion criteria: Randomized clinical trials comparing antihistamine or benzodiazepine use with other comparators, placebo, or no intervention for acute vertigo (duration ≤ 2 weeks).
• Exclusion criteria: Studies involving healthy volunteers, prophylactic treatment, induced vertigo, or comparisons between medications from the same class.
• Data extraction: Two authors independently extracted data and assessed the risk of bias for each study.
• Statistical analysis: Data were pooled using a random-effects model.

This comprehensive approach allowed the researchers to gather and analyze a significant amount of data, providing a robust foundation for their conclusions.

Primary Outcome Measures and Key Findings

The primary outcome of the study was the change in vertigo or dizziness visual analog scale (VAS) scores at 2 hours after treatment. The VAS scores were measured on either a 10-point or 100-point scale, providing a quantitative measure of symptom improvement.

What were the main findings of the study regarding the efficacy of antihistamines and benzodiazepines? The analysis revealed:

1. Antihistamines demonstrated greater patient improvement compared to benzodiazepines, with a difference of 16.1 points on the 100-point VAS scale.
2. Antihistamines were not found to be superior to other active comparators, including ondansetron, droperidol, metoclopramide, and piracetam.
3. The use of benzodiazepines for acute vertigo treatment was discouraged based on the study’s findings.

These results suggest that antihistamines may be a more effective option for managing acute vertigo symptoms compared to benzodiazepines.

Secondary Outcomes and Additional Insights

In addition to the primary outcome, the researchers examined several secondary outcomes to provide a more comprehensive understanding of the treatment efficacy. These secondary measures included:

• Change in nausea VAS scores at 2 hours after treatment
• Use of rescue medication at 2 hours
• Improvement or resolution of vertigo at 1 week or 1 month

By analyzing these additional factors, the study aimed to capture a broader picture of the overall treatment effectiveness and patient experience. While the specific results for these secondary outcomes were not provided in the available summary, they likely contributed to the researchers’ overall conclusions and recommendations.

Implications for Clinical Practice and Patient Care

The findings of this systematic review and meta-analysis have significant implications for clinical practice and patient care in the treatment of acute vertigo. How might these results influence treatment decisions?

First and foremost, the study suggests that healthcare providers should prioritize antihistamines over benzodiazepines when treating patients with acute vertigo. This recommendation is based on the observed superior efficacy of antihistamines in reducing vertigo symptoms as measured by the VAS scores.

Furthermore, the comparable effectiveness of antihistamines to other active comparators such as ondansetron, droperidol, metoclopramide, and piracetam indicates that clinicians have multiple viable options for vertigo treatment. This allows for personalized treatment approaches based on individual patient factors, potential side effects, and medication availability.

The study’s findings also underscore the importance of evidence-based medicine in guiding treatment decisions. By relying on data from well-designed randomized clinical trials, healthcare providers can make more informed choices and potentially improve patient outcomes.

Limitations and Future Research Directions

While this systematic review and meta-analysis provide valuable insights into the treatment of acute vertigo, it is essential to consider potential limitations and areas for future research. Some aspects to consider include:

• Study heterogeneity: The analysis included trials with varying methodologies, patient populations, and specific medications within the antihistamine and benzodiazepine classes. This heterogeneity may impact the generalizability of the results.
• Long-term outcomes: The primary focus on short-term symptom improvement (2 hours post-treatment) leaves questions about the long-term efficacy and safety of these medications for vertigo treatment.
• Underlying causes: Acute vertigo can result from various underlying conditions. Future research could explore whether the efficacy of antihistamines and benzodiazepines varies depending on the specific etiology of vertigo.
• Combination therapies: Investigation into the potential synergistic effects of combining different medication classes or non-pharmacological interventions could provide additional treatment options for patients with acute vertigo.

Addressing these limitations and exploring new research directions will further enhance our understanding of vertigo treatment and potentially lead to improved patient care strategies.

The Role of Antihistamines in Vertigo Management

Given the study’s findings favoring antihistamines over benzodiazepines, it is worth exploring the mechanisms by which antihistamines may alleviate vertigo symptoms. Antihistamines are primarily known for their role in managing allergic reactions, but they also have effects on the vestibular system that can be beneficial for vertigo patients.

How do antihistamines work to reduce vertigo symptoms? The primary mechanisms include:

1. Vestibular suppression: Some antihistamines can suppress the activity of the vestibular system, reducing the sensation of spinning or dizziness.
2. Anticholinergic effects: Many antihistamines have anticholinergic properties, which can help reduce nausea and vomiting often associated with vertigo.
3. Sedation: The mild sedative effect of some antihistamines may help patients relax and better cope with vertigo symptoms.

Common antihistamines used in vertigo treatment include meclizine, dimenhydrinate, and promethazine. These medications are generally well-tolerated, with drowsiness being the most common side effect. However, it is essential for healthcare providers to consider individual patient factors, such as age, other medications, and underlying health conditions, when prescribing antihistamines for vertigo.

Alternatives to Pharmacological Interventions for Vertigo

While the study focused on pharmacological treatments for acute vertigo, it is important to note that non-pharmacological interventions can also play a crucial role in managing vertigo symptoms. These alternative approaches can be used alone or in conjunction with medication to provide comprehensive care for vertigo patients.

What are some effective non-pharmacological interventions for vertigo? Consider the following options:

• Vestibular rehabilitation therapy: This specialized form of physical therapy aims to retrain the brain to process balance information more effectively, reducing vertigo symptoms over time.
• Canalith repositioning procedures: For vertigo caused by benign paroxysmal positional vertigo (BPPV), specific head maneuvers can help reposition displaced calcium crystals in the inner ear.
• Lifestyle modifications: Simple changes such as avoiding sudden head movements, staying hydrated, and managing stress can help reduce the frequency and severity of vertigo episodes.
• Cognitive-behavioral therapy: This form of psychotherapy can help patients develop coping strategies and reduce anxiety associated with vertigo.

Integrating these non-pharmacological approaches with appropriate medication use, as informed by the study’s findings, can provide a well-rounded treatment plan for patients suffering from acute vertigo.

In conclusion, the systematic review and meta-analysis conducted by Hunter et al. provide valuable insights into the efficacy of antihistamines and benzodiazepines for acute vertigo treatment. The findings suggest that antihistamines may be more effective than benzodiazepines in managing vertigo symptoms, while also highlighting the need for individualized treatment approaches and further research in this area. By combining these evidence-based pharmacological interventions with non-pharmacological strategies, healthcare providers can offer comprehensive care to patients experiencing the debilitating effects of acute vertigo.

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, MD^1,2; et al
Paul I. Musey Jr, MD¹; Christian C. Strachan, MD¹; Steven K. Roumpf, MD¹; Steven L. Propst, MD^1,3; 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 May 20, 2020 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

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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.

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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.