Efficacy of cinnarizine/dimenhydrinate compared to betahistine in the Management of Adults with Peripheral Vestibular Disorder: A Systematic Review of Randomized Controlled Trials


Objective: To compare the effectiveness of cinnarizine/dimenhydrinate with betahistine in the management of Adult patients with Peripheral Vestibular Disorder

Data sources: A systematic review of English articles by searching electronic Databases at the University of Santo Tomas (Cochrane, Medline, CINAHL, PubMed, ScienceDirect, DOAJ, Biomed Central), Libraries in Metro Manila, Hard copies of journals and Professional Societies were identified. The search was done from May 2012 to July 2012 using the following search terms: Betahistine*; Cinnarizine*; and vertigo* or dizziness*.

Study Selection: Only double-blind Randomized Controlled Trials studying the administration of cinnarizine/dimenhydrinate or betahistine on patients with peripheral vestibular disorder were included. Quality of data was assessed using CASP: Randomized Controlled Trial Appraisal Tool.

Data Extraction: One review author extracted the data from included studies using pre-defined data fields and the other author checked the extracted data. 

Data Synthesis: All pooled analysis was based on fixed effect models.  Two RCTs (n=127) met our inclusion criteria.  Heterogeneity was observed in both studies after 1 week of treatment, which was reduced when compared after 4 weeks of treatment. A fixed combination of cinnarizine 20mg/dimenhydrinate 40mg 3x a day significantly reduced the weighted mean difference (p-Value 0.00001, 95% confidence interval) of the mean vertigo score and the WMD (p-Value 0.002, 95% confidence interval) of the concomitant symptom score after 4 weeks of treatment.  No statistical significant difference in Vestibulospinal and Vestibuloocular tests.

Conclusions: This systematic review of Randomized Controlled Trials confirms that the fixed combination of cinnarizine/dimenhydrinate could decrease the intensity of vertigo and improve the concomitant symptoms better than betahistine after 4 weeks of treatment (Grade C Recommendation, NHMRC guidelines 2009).  

  1. Luscher M, Theilgaard S, Edholm B. Prevalence and characteristics of diagnostic groups amongst 1034 patients seen in ENT practices for dizziness. J Laryngol Otol. 2014; 1-6.
  2. Sloane PD. Dizziness in primary care: results from the national ambulatory medical care service. J Fam Pract 1989;29:33–8.
  3. Maarsingh OR, Dros J, Schellevis FG, et al. Dizziness reported by elderly patients in family practice: prevalence, incidence and clinical characteristics. MC Family Practice 2010, 11:2 Available from http://www.biomedcentral.com/1471-2296/11/2
  4. Luxon LM. Evaluation and management of the dizzy patient. J Neurol Neurosurg Psychiatry 2004; 75 Suppl. 4: iv45-52.
  5. Hamid MA. Overview of clinical anatomy and physiology of the vestibular system. In: Arenberg IK, editor. Dizziness and balance disorders. Amsterdam: Kugler Publications, 1993: 41-3.
  6. Novotny M, Kostrica R. Fixed combination of cinnarizine and dimenhydrinate versus betahistine dimesylate in the treatment of Meniere’s disease: a randomized, double-blind, parallel group clinical study. Int Tinnitus J 2002; 8: 115-23
  7. Hain TC, Uddin M. Pharmacological treatment of vertigo. CNS Drugs 2003; 17: 85-100.
  8. Pytel J, Nagy G, Toth A, et al. 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, outpa- tient study. Clin Ther 2007; 29: 84-98
  9. National Health and Medical Research Council. NHMRC levels of evidence and grades fro recommendations for developers of guidelines. 2009 Dec. Avaialble from https://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/developers/nhmrc_levels_grades_evidence_120423.pdf

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