Categories
Change Password!
Reset Password!
Intravenously administered diphenhydramine + sodium bicarbonate offers excellent 60-minute vertigo relief and markedly reduces rescue medication use compared with diphenhydramine alone in acute peripheral vertigo.
In a triple-arm, randomized clinical trial, emergency department (ED) patients with acute peripheral vertigo experienced noticeably greater symptom improvement and reduced rescue therapy when treated with a combination of intravenous diphenhydramine and intravenous sodium bicarbonate.
A total of 222 patients (mean age 57.9 ± 17.6 years; 67.6% women) presenting within 24 hours of vertigo onset were analyzed under a modified intention-to-treat framework. Patients were excluded if they were pregnant, had taken prior antivertigo medications, had symptoms lasting more than 24 hours, or had heart failure, chronic kidney disease, drug allergy, or declined participation. Volunteers were randomized (1:1:1) to receive:
The key endpoint was the alteration in vertigo intensity at 60 minutes, measured via a 10-point visual analog scale (VAS). Secondary endpoints were adverse events, nausea severity, rescue medication use, and ED length of stay. Compared with Group A, Group C provided greater vertigo improvement and lowered the need for rescue therapy, with the strongest response seen in younger men without previous vertigo.
Group B demonstrated comparable efficacy to Group A. Adverse events varied across treatment groups: moderate lethargy was more frequent in diphenhydramine-containing regimens, whereas injection-site discomfort was more commonly reported with sodium bicarbonate (Table 1).
There were no statistically significant differences among groups in nausea scores or ED length of stay. For emergency physicians managing acute peripheral vertigo, combining intravenous diphenhydramine with sodium bicarbonate offers enhanced short-term symptom control and substantially lowers rescue medication requirements, without prolonging ED stay. The differing adverse-effect profiles—sedation versus injection discomfort—should inform individualized treatment decisions.
JAMA Network
Diphenhydramine, Sodium Bicarbonate, or Combination for Acute Peripheral Vertigo A Randomized Clinical Trial
Chien-Yu Chi et al.
Comments (0)