Adams Meredith E, Karaca-Mandic Pinar, Marmor Schelomo
Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis.
Now with Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor.
JAMA Otolaryngol Head Neck Surg. 2025 Jul 24. doi: 10.1001/jamaoto.2025.2052.
Among adults who present with dizziness, there is a critical need to identify and deimplement low-value and guideline-discordant care to mitigate the risk of falls over time. Meclizine, an antihistamine with anticholinergic properties, is the most used antiemetic vestibular suppressant in the US.
To determine the factors associated with meclizine use and subsequent falls among patients aged 18 to 64 years and those aged 65 years or older with dizziness.
DESIGN, SETTING, AND POPULATION: This cohort study assessed US commercial and Medicare Advantage claims among 805 454 adults (aged ≥18 years) with new diagnoses of dizziness between 2006 and 2015. Data were analyzed from July 2024 to February 2025.
Prescription of meclizine within 30 days of a new dizziness diagnosis.
The main outcome measure was falls resulting in medical evaluation. Fall outcomes were attributed to meclizine use if they occurred within 60 days of a meclizine prescription. Associations of falls and meclizine with presentation setting, diagnoses, and sociodemographic characteristics were estimated with multivariable analyses.
Of 805 454 individuals with dizziness (502 055 women [62%]; median age, 52 years [range, 18-87 years]), 8% received a meclizine prescription. Among those prescribed meclizine, 5792 (9% overall; 10% [2189/21 700] aged 18-64 years and 9% [3603/40 138] aged ≥65 years) experienced an injurious fall. When adjusting for sociodemographics and clinical factors, a filled meclizine prescription was associated with subsequent falls in those aged 18 to 64 years (hazard ratio, 2.94; 95% CI, 2.81-3.08) and those aged 65 years or older (hazard ratio, 2.54; 95% CI, 2.42-2.66).
This study found that although meclizine may offer immediate vertigo relief, use is incongruent with guideline-concordant care for common vestibular diagnoses. Receipt of a meclizine prescription was associated with an increased risk of injurious falls among both patients aged 65 years or older and those aged 18 to 64 years with dizziness, who are already fall prone. Future prospective and mechanistic studies may further elucidate the relationship between vestibular suppressants and fall risk, and future guidelines that engage clinicians and patients to deimplement routine vestibular suppressant use for dizziness may be warranted.
在出现头晕症状的成年人中，迫切需要识别并摒弃低价值且不符合指南的护理措施，以降低长期跌倒风险。美克洛嗪是一种具有抗胆碱能特性的抗组胺药，是美国最常用的抗呕吐前庭抑制剂。
确定18至64岁以及65岁及以上头晕患者使用美克洛嗪及随后跌倒的相关因素。
设计、地点和人群：这项队列研究评估了2006年至2015年间805454名新诊断为头晕的18岁及以上美国成年人的商业保险和医疗保险优势计划理赔数据。数据于2024年7月至2025年2月进行分析。
新诊断头晕后30天内开具美克洛嗪处方。
主要结局指标是导致进行医学评估的跌倒。如果跌倒发生在美克洛嗪处方开具后的60天内，则将跌倒结局归因于美克洛嗪的使用。通过多变量分析估计跌倒和美克洛嗪与就诊环境、诊断及社会人口学特征之间的关联。
在805454名头晕患者中（502055名女性[62%]；年龄中位数52岁[范围18 - 87岁]），8%接受了美克洛嗪处方。在开具美克洛嗪处方的患者中，5792人（总体9%；18至64岁患者中为10%[2189/21700]，65岁及以上患者中为9%[3603/40138]）发生了致伤性跌倒。在对社会人口学和临床因素进行调整后，开具美克洛嗪处方与18至64岁患者（风险比2.94；95%置信区间2.81 - 3.08）以及65岁及以上患者（风险比2.54；95%置信区间2.42 - 2.66）随后的跌倒相关。
本研究发现，尽管美克洛嗪可能能立即缓解眩晕，但对于常见前庭诊断的使用与符合指南的护理不一致。开具美克洛嗪处方与65岁及以上以及18至64岁本就容易跌倒的头晕患者发生致伤性跌倒的风险增加相关。未来的前瞻性和机制性研究可能会进一步阐明前庭抑制剂与跌倒风险之间的关系，未来或许有必要制定指南，促使临床医生和患者摒弃针对头晕常规使用前庭抑制剂的做法。
