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Comparison of efficacy dimenhydrinate and metoclopramide in the treatment of nausea due to vertigo; a randomized study

Published:December 10, 2020DOI:https://doi.org/10.1016/j.ajem.2020.12.010

      Abstract

      Background

      This study aimed to compare the therapeutic efficacy of dimenhydrinate and metoclopramide in patients with nausea and vertigo.

      Methods

      A prospective, double-blind, randomized clinical trial was performed on patients who presented to the emergency department (ED) with nausea and vertigo in the six month period between Nov 1st 2012 and May 1st 2013. Adult patients who were 18 to 65 years old presenting to the ED with nausea and vertigo or motion sickness were included in the study. A total of 200 patients were divided into 2 groups who were admitted to ED with complaints of vertigo accompanied by nausea. In the first group, 50 mg dimenhydrinate and 10 mg metoclopramide infusions were given intravenously for 15 min. The efficacy of treatment was measured by using a 10 mm Visual Analog Scale (VAS) performed at 0, 15 and the 30th minute. The primary outcome variable was a reduction in vertigo intensity documented on the VAS at the 30th minute after medication administration.

      Results

      A total of 200 patients were included in the randomization (n=100 in both groups). The baseline vertigo VAS scores were 7.57±1.42 in the dimenhydrinate (DMT) group and 7.27±1.40 in the metoclopramide (MTP) group (p=0.09). In the 30th minute of treatment, the average vertigo VAS score was 2.46 ± 2.39 in the DMT group and 2.31±1.96 in the MTP group; no significant differences were detected between groups. The baseline nausea VAS scores were 7.62±1.48 in the DMT group and 7.45±1.27 in the MTP group (p=0.36). In the 30th minute of treatment the average vertigo VAS score decreased to 2.27±2.24 in the DMT group and 2.70±2.48 in the MTP group, no significant differences were detected between groups. No significant differences were detected between nausea VAS changes and vertigo VAS changes at 30th minutes of the treatment (p=0.06, p=0.85 respectively). Rescue medication need was similar in both treatment groups (p=0.94). No significant differences were detected about the side effects which are sedation (p=0.56) and hypotension (p=0.57).

      Conclusions

      In conclusion, this prospective, double-blind, randomized study showed that both DMT and MTP have similar efficacy in reducing nausea and vertigo symptoms in the ED.

      Keywords

      Abbreviations:

      ED (Emergency Department), VAS (Visual Analog Scale), DMT (Dimenhydrinate), MTP (Metoclopramide), PONV (Postoperative Nausea and Vomiting), NRS (Numeric Rating Scale)
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      References

        • Wood C.D.
        • Stewart J.J.
        • Wood M.J.
        • Mims M.
        Effectiveness and duration of intramuscular antimotion sickness medications.
        J Clin Pharmacol. 1992; 32: 1008-1012https://doi.org/10.1002/j.1552-4604.1992.tb03803.x
        • Pyykkö I.
        • Schalen L.
        • Jäntti V.
        Transdermally administered scopolamine vs. dimenhydrinate: I. effect on nausea and vertigo in experimentally induced motion sickness.
        Acta Otolaryngol. 1985; 99: 588-596https://doi.org/10.3109/00016488509182265
        • Irving C.
        • Richman P.
        • Kaiafas C.
        • Eskin B.
        • Allegra J.
        Intramuscular droperidol versus intramuscular dimenhydrinate for the treatment of acute peripheral vertigo in the emergency department: a randomized clinical trial.
        Acad Emerg Med. 2002; 9: 650-653https://doi.org/10.1197/aemj.9.6.650
        • Neuhauser H.K.
        • Von Brevern M.
        • Radtke A.
        • Lezius F.
        • Feldmann M.
        • Ziese T.
        • et al.
        Epidemiology of vestibular vertigo: a neurotologic survey of the general population.
        Neurology. 2005; 65: 898-904https://doi.org/10.1212/01.wnl.0000175987.59991.3d
        • Newman-Toker D.E.
        • Hsieh Y.H.
        • Camargo Jr., C.A.
        • Pelletier A.J.
        • Butchy G.T.
        • Edlow J.A.
        Spectrum of dizziness visits to US emergency departments: cross-sectional analysis from a nationally representative sample.
        Mayo Clin Proc. 2008; 83: 765-775https://doi.org/10.4065/83.7.765
        • Doğan N.Ö.
        • Avcu N.
        • Yaka E.
        • Yılmaz S.
        • Pekdemir M.
        Comparison of the therapeutic efficacy of intravenous dimenhydrinate and intravenous piracetam in patients with vertigo: a randomised clinical trial.
        Emerg Med J. 2015; 32: 520-524https://doi.org/10.1136/emermed-2014-204006
        • Swartz R.
        • Longwell P.
        Treatment of vertigo.
        Am Fam Physician. 2005; 71: 1115-1122
        • Donnerer J.
        • Beubler E.
        5-HT3 receptor antagonists in antiemetic therapy.
        in: Antiemetic Therapy. vol. 22. Karger, Basel2003
        • Ryu J.H.
        • McCabe B.F.
        Effects of diazepam and dimenhydrinate on the resting activity of the vestibular neuron.
        Aerospace Med. 1974; 45: 1177-1179
        • Halpert A.G.
        • Olmstead M.C.
        • Beninger R.J.
        Dimenhydrinate produces a conditioned place preference in rats.
        Pharmacol Biochem Behav. 2003; 75: 173-179https://doi.org/10.1016/S0091-3057(03)00068-6
        • Miller L.G.
        • Jankovic J.
        Metoclopramide-induced movement disorders: clinical findings with a review of the literature.
        Arch Intern Med. 1989; 149: 2486-2492https://doi.org/10.1001/archinte.1989.00390110070015
        • Parlak I.
        • Erdur B.
        • Parlak M.
        • Ergin A.
        • Ayrik C.
        • Tomruk O.
        • et al.
        Midazolam vs. diphenhydramine for the treatment of metoclopramide-induced akathisia: a randomized controlled trial.
        Acad Emerg Med. 2007; 14: 715-721https://doi.org/10.1197/j.aem.2007.01.021
        • Ganzini L.
        • Casey D.E.
        • Hoffman W.F.
        • McCall A.L.
        The prevalence of metoclopramide-induced tardive dyskinesia and acute extrapyramidal movement disorders.
        Arch Intern Med. 1993; 153: 1469-1475https://doi.org/10.1001/archinte.1993.00410120051007
        • Friedman B.W.
        • Bender B.
        • Davitt M.
        • Solorzano C.
        • Paternoster J.
        • Esses D.
        • et al.
        A randomized trial of diphenhydramine as prophylaxis against metoclopramide-induced akathisia in nauseated emergency department patients.
        Ann Emerg Med. 2009; 53: 379-385https://doi.org/10.1016/j.annemergmed.2008.08.003
        • Pytel J.
        • Nagy G.
        • Tóth A.
        • Spellenberg S.
        • Schwarz M.
        • Répassy G.
        Efficacy and tolerability of a fixed low-dose combination of cinnarizine and dimenhydrinate in the treatment of vertigo: A 4-week, randomized, double-blind, active-and placebo-controlled, parallel-group, outpatient study.
        Clin Ther. 2007; 29: 84-98https://doi.org/10.1016/j.clinthera.2007.01.010
        • Hahn A.
        • Sejna I.
        • Stefflova B.
        • Schwarz M.
        • Baumann W.
        A fixed combination of cinnarizine/dimenhydrinate for the treatment of patients with acute vertigo due to vestibular disorders.
        Clin Drug Investig. 2008; 28: 89-99https://doi.org/10.2165/00044011-200828020-00003
        • Marill K.A.
        • Walsh M.J.
        • Nelson B.K.
        Intravenous lorazepam versus dimenhydrinate for treatment of vertigo in the emergency department: a randomized clinical trial.
        Ann Emerg Med. 2000; 36: 310-319https://doi.org/10.1067/mem.2000.110580
        • Eberhart L.H.J.
        • Seeling W.
        • Ulrich B.
        • Morin A.M.
        • Georgieff M.
        Dimenhydrinate and metoclopramide alone or in combination for prophylaxis of PONV.
        Can J Anesth. 2000; 47: 780https://doi.org/10.1007/BF03019481
        • Luisi F.A.V.
        • Petrilli A.S.
        • Tanaka C.
        • Caran E.M.M.
        Contribution to the treatment of nausea and emesis induced by chemotherapy in children and adolescents with osteosarcoma.
        Sao Paulo Med J. 2006; 124: 61-65https://doi.org/10.1590/S1516-31802006000
        • Barrett T.W.
        • DiPersio D.M.
        • Jenkins C.A.
        • Jack M.
        • McCoin N.S.
        • Storrow A.B.
        • et al.
        A randomized, placebo-controlled trial of ondansetron, metoclopramide, and promethazine in adults.
        Am J Emerg Med. 2011; 29: 247-255https://doi.org/10.1016/j.ajem.2009.09.028
        • Kapur P.A.
        The big “little problem”.
        Anesth Analg. 1991; 73: 243-245
        • Braude D.
        • Soliz T.
        • Crandall C.
        • Hendey G.
        • Andrews J.
        • Weichenthal L.
        Antiemetics in the ED: a randomized controlled trial comparing 3 common agents.
        Am J Emerg Med. 2006; 24: 177-182https://doi.org/10.1016/j.ajem.2005.08.017
        • Pang W.W.
        • Wu H.S.
        • Lin C.H.
        • Chang D.P.
        • Huang M.H.
        Metoclopramide decreases emesis but increases sedation in tramadol patient-controlled analgesia.
        Can J Anesth. 2002; 49: 1029https://doi.org/10.1007/BF03017896
        • Stanchina M.L.
        • Levy M.M.
        Vasoactive drug use in septic shock.
        Semin Respir Crit Care Med. 2004; 25: 673-681https://doi.org/10.1055/s-2004-860981
        • Morris M.E.
        Compatibility and stability of diazepam injection following dilution with intravenous fluids.
        Am J Health Syst Pharm. 1978; 35: 669-672https://doi.org/10.1093/ajhp/35.6.669
        • Ozdemir H.
        • Akıncı E.
        • Coskun F.
        Comparison of the effectiveness of intravenous piracetam and intravenous dimenhydrinate in the treatment of acute peripheral vertigo in the emergency department.
        Singap Med J. 2013; 54: 649-652https://doi.org/10.11622/smedj.2013225
        • Rubio S.
        • Weichenthal L.
        • Andrews J.
        Motion sickness: comparison of metoclopramide and diphenhydramine to placebo.
        Prehosp Disaster Med. 2011; 26: 305-309https://doi.org/10.1017/S1049023X11006431
        • Sırajuddın M.
        • Nadeem Naqvı S.M.
        • Murtaza G.
        • Abbas N.
        Metoclopramide alone and metoclopramide with dimenhydrinate for prophylaxis of post operative nausea and vomiting in patients admitted in day care for breast surgery.
        Med Channel. 2014; 20: 39-42
        • Wagner B.K.
        • Berman S.L.
        • Devitt P.A.
        • Halvorsen M.B.
        • O’Hara D.A.
        A double-blind, placebo-controlled evaluation of intranasal metoclopramide in the prevention of postoperative nausea and vomiting.
        Pharmacotherapy. 1996; 16: 1063-1069https://doi.org/10.1002/j.1875-9114.1996.tb03034.x
        • Hain T.C.
        • Uddin M.
        Pharmacological treatment of vertigo.
        CNS Drugs. 2003; 17: 85-100https://doi.org/10.2165/00023210-200317020-00002