Is cinnarizine/betahistine combination superior to respective monotherapies in treatment of vertigo? Comment on a randomized triple-blind placebo-controlled trial

  • Kiumarth Amini
  • Maryam Taghizadeh-GhehiEmail author
Letter to the Editor

We read with great interest the report of a randomized, triple-blind, placebo-controlled trial (RCT) conducted by Asadi et al. [1], to compare efficacy of cinnarizine and betahistine combination with their monotherapies in patients with acute peripheral vertigo (APV). Despite abundant use of betahistine for vertigo, a Cochrane systematic review concluded that available supporting evidence had low quality [2, 3]. The study by Asadi et al. could provide valuable evidence if its robustness was assured. The authors concluded that cinnarizine and betahistine monotherapies were effective but the combination was superior; however, the conclusion would be questionable considering following points.

First question emerged regarding the study inclusion and exclusion criteria. We faced ambiguity in the term “APV.” Whether it meant patients with acute vestibular vertigo or peripheral vertigo with unknown origin was unclear. It was not clear either, whether severity of the symptoms, history of...



  1. 1.
    Asadi P, Zia Ziabari SM, Majdi A, Vatanparast K, Naseri Alavi SA (2019) Cinnarizine/betahistine combination vs. the respective monotherapies in acute peripheral vertigo: a randomized triple-blind placebo-controlled trial. Eur J Clin Pharmacol 75(11):1513–1519. CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Vanderkam P, Blanchard C, Naudet F, Pouchain D, Vaillant Roussel H, Perault-Pochat MC, Jaafari N, Boussageon R (2019) Efficacy of acetylleucine in vertigo and dizziness: a systematic review of randomised controlled trials. Eur J Clin Pharmacol 75(5):603–607. CrossRefGoogle Scholar
  3. 3.
    Murdin L, Hussain K, Schilder AGM (2016) Betahistine for symptoms of vertigo. Cochrane Database Syst Rev 6.
  4. 4.
    Scholtz AW, Hahn A, Stefflova B, Medzhidieva D, Ryazantsev SV, Paschinin A, Kunelskaya N, Schumacher K, Weisshaar G (2019) Efficacy and safety of a fixed combination of cinnarizine 20 mg and dimenhydrinate 40 mg vs betahistine dihydrochloride 16 mg in patients with peripheral vestibular vertigo: a prospective, multinational, multicenter, double-blind, randomized, non-inferiority clinical trial. Clinical drug investigation 39(11):1045–1056. CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Cirek Z, Schwarz M, Baumann W, Novotny M (2005) Efficacy and tolerability of a fixed combination of cinnarizine and dimenhydrinate versus betahistine in the treatment of otogenic vertigo : a double-blind, randomised clinical study. Clinical drug investigation 25(6):377–389. CrossRefPubMedGoogle Scholar

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© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Department of Clinical Pharmacy, Faculty of PharmacyTehran University of Medical SciencesTehranIran
  2. 2.Research Center for Rational Use of DrugsTehran University of Medical SciencesTehranIran

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