Comparison of Efficacy of Metoclopramide, Promethazine and Prochlorperazine in the Treatment of Peripheral Vertigo in the Emergency Department a Triple-Blind, Randomized Controlled Trial, Multi-Centers
Asma Salim Abdallah Al Buraiki*, Suad Said Khamis Albulushi, Ahmed Al Abri, AbdulAziz Al Bareiki, Fatema Al Rawahi, Khawther Al Rahbi and Hana Al Ghasani
Abstract
Objective: Acute vertigo is a common presentation in the emergency department (ED). This study aimed to compare the therapeutic efficacy of metoclopramide, promethazine, and prochlorperazine administered via intramuscular (IM) route in patients presenting with signs and symptoms suggestive of acute peripheral vertigo to the ED. The primary outcome was to determine the most effective medication for treating vertigo in this patient population, with the secondary outcome assessing the need for rescue medication.
Methods: A triple-blind, multi-center, randomized controlled trial was conducted. Adult patients aged 18–60 years with peripheral vertigo, self-assessed with a visual analogue scale (VAS) rating of ≥5.0, were included. Participants were randomized to receive a single dose of metoclopramide, promethazine, or prochlorperazine via IM route. The primary endpoint was a reduction in VAS score at 60 minutes. Efficacy was defined as a VAS score ≤3 at 60 minutes with the least side effects and reduced need for rescue medication or maneuver. Data were analyzed using SPSS.
Results: A total of 90 patients were allocated to receive metoclopramide, prochlorperazine, or promethazine via IM route, with 30 participants in each group showing similar characteristics. The mean VAS scores deference between 0- and 60-minutes post-treatment were 4.23 (95% CI: 2.882, 5.583) for metoclopramide, 4.766 (95% CI: 3.758, 5.774) for prochlorperazine, and 4.033 (95% CI: 2.775, 5.290) for promethazine in the supine position. The mean VAS scores deference between 0- and 60-minutes post-treatment were 4.8 (95% CI: 3.617, 5.982) for metoclopramide, 5.1 (95% CI: 4.042, 6.157) for prochlorperazine, and 4.733 (95% CI: 3.686, 5.700) for promethazine in the sitting position. The mean VAS scores difference between 0- and 60-minutes post-treatment were 5.5 (95% CI: 4.214, 6.785) for metoclopramide, 5.9 (95% CI: 4.767, 7.165) for prochlorperazine, and 5.0 (95% CI: 3.740, 6.259) for promethazine in the standing position. Based on these ANOVA results, there is no significant evidence to reject the null hypothesis that there are no differences between groups for each of the variables tested. The factors (between groups) do not significantly explain the difference in the scores for VAS score difference in three positions of assessment.
Conclusions: The results suggest that there are no significant differences in VAS scores at 60 minutes postmedication between three medication groups in supine (P= 0.705), sitting positions (p:0.839) and standing position (P= 0.494). Clinically, Difference in VAS score in standing position were higher in prochlorperazine group compare to metoclopramide and promethazine group. Metoclopramide group required more rescue medication, while the prochlorperazine group required the least. No adverse effects were noted in any group. Additionally, there was no statistically significant difference in the use of rescue medication among the three groups managed with simple manoeuvres. All patients were discharged from the ED, except one who was admitted for a posterior circulation stroke with no side effect observed from the use of medication in the study.