title: Intravenous promethazine versus lorazepam for the treatment of peripheral vertigo in the emergency department: A double blind, randomized clinical trial of efficacy and safety.
abstract: BACKGROUND
  Vertigo imposes considerable health restrictions with significant impact on the patient's quality of life. The most effective antivertigo agent is undetermined thus far.
  
  
  OBJECTIVE
  This study was performed to assess whether promethazine has superior vertigo reduction compared with lorazepam in ED patients.
  
  
  METHODS
  In this randomized, double-blind, parallel group trial 184 patients were assigned (1:1 ratio) to receive either promethazine, 25 mg intravenously, or lorazepam, 2 mg intravenously. Primary endpoint was mean change in vertigo intensity at 2 hours measured using visual analog scale (VAS). Secondary endpoints were mean change in nausea score, need for second dose of study medications, and adverse events (AEs).
  
  
  RESULTS
  Promethazine was associated with significantly more reduction (46.5 mm) in vertigo than lorazepam (25.7 mm, p< 0.001). Mean change in nausea score 2 hours after drug injection on the VAS was 28.7 mm for promethazine and 22.8 for lorazepam (p=0.002). The most frequently reported AEs were lethargy (14.1% in lorazepam group, 4.3% in promethazine group, p=0.013) and drowsiness (10.8% for promethazine, 2.1% for lorazepam, p=0.017).
  
  
  CONCLUSIONS
  Our study demonstrated the evidence that promethazine is superior to lorazepam in management of peripheral vertigo and vertigo-related nausea in ED adults.
authors.affiliation: Department of Emergency Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Afshin
authors.initials: A
authors.lastname: Amini
authors.affiliation: Department of Emergency Medicine, Shohadaye-Haftom Tir Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Kamran
authors.initials: K
authors.lastname: Heidari
authors.affiliation: School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Shadi
authors.initials: S
authors.lastname: Asadollahi
authors.affiliation: Department of Emergency Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Tahereh
authors.initials: T
authors.lastname: Habibi
authors.affiliation: Department of Emergency Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Shahrami
authors.affiliation: Department of Neurology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Behnam
authors.initials: B
authors.lastname: Mansouri
authors.affiliation: Department of Emergency Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Hamidreza
authors.initials: H
authors.lastname: Kariman
mesh_terms: D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008140:Lorazepam / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000188:drug therapy*; D011398:Promethazine / Q000627:therapeutic use*; D014717:Vertigo
chemical_list: D011398:Promethazine; D008140:Lorazepam
keywords: Vertigo; clinical trial; lorazepam; nausea; promethazine