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

Cristopher Ed C. Gloria, Francis V. Roasa, Norberto V. Martinez

Sep 2017 DOI 10.35460/2546-1621.2017-0007     Access   

Abstract

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).  

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