Intravenous promethazine versus lorazepam for the treatment of peripheral vertigo
in the emergency department: A double blind, randomized clinical trial of
efficacy and safety.
Author(s): Amini A(1), Heidari K(2), Asadollahi S(3), Habibi T(1), Shahrami A(1), Mansouri
B(4), Kariman H(1).
Affiliation(s): Author information:
(1)Department of Emergency Medicine, Imam Hossein Hospital, Shahid Beheshti
University of Medical Sciences, Tehran, Iran.
(2)Department of Emergency Medicine, Shohadaye-Haftom Tir Hospital, Shahid Beheshti
University of Medical Sciences, Tehran, Iran.
(3)School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
(4)Department of Neurology, Imam Hossein Hospital, Shahid Beheshti University of
Medical Sciences, Tehran, Iran.
Publication date & source: 2014, J Vestib Res. , 24(1):39-47
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.
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