5/8/2023 0 Comments Meclizine for vertigo![]() This brings us back to the original article comparing meclizine to diazepam in treating vertigo, keeping in mind that not all vertigo is caused by BPPV. Despite this, the author’s summary expresses concern about the lack of CRP offered in the ED (less than 4%), and state “what barriers exist to prevent it’s regular use is difficult to explain.” They go on the conclude “Considering the cost savings, nursing time, and potential for adverse reactions to medications (even the limits on driving due to sedation) and complications from IV access, it seems the maneuvers has clear advantages for those so motivated to attempt it.” They found no significant differences between the two groups. ![]() Some were treated with Canalith Repositiong Procedures (CRP), while others were treated with vestibular suppressant medication. This article recognizes that “It is common practice for ED physicians to treat these (BPPV) patients symptomatically with benzodiazepines, antihistamines, or anticholinergic medications.” This study compared levels of nausea, dizziness and patient satisfaction in two groups of patients diagnosed with BPPV. The second reference article is more recent, published in The Journal of Emergency Medicine in 2014. Short term use on an as-needed basis in patients with severe symptoms may be appropriate provided adequate follow up with an otolaryngologist or neurologist is obtained.” So, even before the 2008 BPPV Clinical Practice Guideline came out, there was some recognition of the problems associated with treating BPPV with meclizine or diazepam. They may diminish the intensity of the attacks and prevent the patient from seeking treatment from a potentially curable disease, and they often worsen the patients imbalance. I downloaded and read the two articles referenced for the statement about “questions were raised regarding the effectiveness of CRM for BPPV in the ED setting.” Here is the gist of those two articles:Ī 2000 review article in the Annals of Emergency Medicine states “Routine use of vestibular suppressants (meclizine and benzodiazepines) as primary therapy is discouraged because they do not reduce the frequency of attacks of vertigo. However, questions were raised regarding the effectiveness of CRM for BPPV in the ED setting” An emergency medicine evidence-based medicine analysis identified ED setting studies. The preponderance of CRM studies of effectiveness for BPPV were completed in outpatient non-ED settings. However, the ED literature is less clear on this issue. “When a diagnosis of BPPV has been made in the outpatient setting, many experts advocate for the first-line therapy of a canalith repositioning procedure (CRM). While the article does recognize that canalith repositioning is the best option for the treatment of BPPV, the authors state that: Yet, this recent article describes meclizine as a treatment option for BPPV. This is not new information as the initial BPPV guideline published in 2008 says essentially the same thing. Recommendation against routine medication based on observational studies and a preponderance of benefit over harm. MEDICAL THERAPY: Clinicians should not routinely treat BPPV with vestibular suppressant medications such as antihistamines and/or benzodiazepines. If you read the AAO-HNS Clinical Practice Guideline for BPPV, you will find this : ![]() If you Google “BPPV meclizine”, you will find a number of posts telling you this is not the best treatment. I sometime feel this way about meclizine, because, despite a lot of recent information recommending against the use of meclizine for most types of “dizziness,” it is still being used on a too frequent basis. The potential victims are hugging and celebrating their victory, not paying any attention to the bad guy with the axe in his chest and BOOM! The bad guy gets up, takes the axe out of his chest and starts swinging at the knuckleheaded couple that probably should have hightailed it out of there when they had the chance. He has an axe in his chest, or something equally unsurvivable (is that a word?). Reading over a recent article published in the Journal of Emergency Medicine that compares the effectiveness of meclizine versus diazepam for treating vertigo (including BPPV), I was reminded of that cliché scene in so many horror movies.
0 Comments
Leave a Reply. |