Flunarizine versus betahistine in vertigo: a systematic review
Abstract
OBJECTIVE
To compare the efficacies of flunarizine and betahistine in patients with vertigo.
METHODS
We systematically searched electronic databases from the Cochrane Library, PubMed, Trip Database and Scopus. The other resource that we searched included web directory (google scholar). We also made hand searching. We included the previous randomized controlled trials (RCTs) regarding the efficacy of flunarizine comparing with betahistine. Our primary outcome was vegetative symptoms improvement after 2 months and the secondary outcome was vegetative symptoms improvement after 1 month, free attack of vertigo, gastrointestinal (GI) disorders, and drowsiness.
RESULTS
It showed that the percentage of patients with improvement of vegetative symptoms after 2 months was significantly higher in flunarizine 10 mg once a day than in betahistine 8 mg three times a day (65% vs. 43.9%; relative risk (RR), 0.62; 95% confidence interval (CI), [0.41 to 0.94]. There were similar percentages of patients with improvement of vegetative symptoms after 2 months in those using flunarizine 10 mg once a day and betahistine 16 mg three times a day (52.0% vs. 61.4%; RR, 1.24; 95% CI, [0.74 to 2.08]; I2=25%). There were also a similar proportion of patients with improvement of vegetative symptoms after 1 month in those using 10 mg of flunarizine and in any doses of betahistine (40.2% vs. 40%; RR, 1.08; 95% CI, [0.62 to 1.88]; I2=70%). The rate of free attack of vertigo was significantly higher in 10 mg of flunarizine than in any doses of betahistine (73.6% vs. 41.2%; RR, 0.49; 95% CI, [0.25 to 0.94]; I2=64%). There was no significant difference between flunarizine and betahistine in rate of GI disorders (5.7% vs. 15.3%; RR, 1.06; 95% CI, [0.80 to 1.42]; I2=87%) but rate of drowsiness was significantly higher in flunarizine group than in betahistine group (23.0% vs. 7.1%; RR, 0.70; 95% CI, [0.25 to 1.99]; I2=94%).
CONCLUSION
Among patients experiencing vertigo, flunarizine and betahistine did not significantly reduce vegetative symptoms after 2 months.
