Dr. Anna Wolfson says she sees dangerous misuse of the allergic drug diphenhydramine every day at her clinic.
“If someone is having an allergic reaction to food, people will say, ‘Don’t worry, I have diphenhydramine in my wallet’, and then say, ‘Really, epinephrine is the first line treatment for food allergies’.”
Diphenhydramine can be harmful if people take it after they have an allergic reaction to food, she said.
“It’s time to move on. For all the signs that people are using diphenhydramine, there are better medications that are more effective in treating the symptoms people are trying to treat with fewer side effects,” she said. “I have had a patient who was worried that diphenhydramine might be impairing his ability to drive and fully participate in everyday life.”
Wolfson doesn’t just like alternatives. In a review published in February, San Diego, an allergy expert at Johns Hopkins University and the University of California, called for the removal of diphenhydramine from the US commercial and prescription markets.
First generation antihistamines, approved in 1946, are widely used for allergies, sleep aids and cold symptoms. According to the American Association of Pharmacists, it is a common over-the-counter drug in the United States, and it has increased in summer months to use sneezing and watery nose caused by grass and pollen allergies.
Despite its long-standing presence in American homes, the authors of the new review say it poses more disproportionate risks than new antihistamines, especially for children and older adults.
“Patients should test alternatives like loratadine, zyrtec, cetirizine, or allegra, fexofenadine,” said Dr. James Clark, who was a prime faculty at CNN, to alleviate allergic symptoms.
The Consumer Healthcare Products Association, a leading figure in the OTC medical industry, says the label reveals common side effects associated with products containing diphenhydramine. However, he states, “these products are not intended for long-term use.”
“When used according to the instructions, these medications offer established therapeutic benefits for common health diseases such as allergies, colds, exercise sickness, mild skin irritation, and occasional insomnia,” the group said in a statement on behalf of Benadril manufacturer Kemb. “As with all medicines, responsible use is essential, and consumers should always follow the instructions and warnings on the drug fact label and consult their healthcare provider if they have questions.”
If you have an allergy, you may want to avoid this type of medicine
Antihistamines work by blocking receptors called H1, which are part of the body’s system, to respond to allergens that cause symptoms such as sneezing, itching, and runny nose. However, older drugs like diphenhydramine not only block allergy-related receptors, they can also affect other parts of the brain. Diphenhydramine often causes sedation, cognitive impairment and, in some cases, dangerous cardiac effects, the authors write.
In older people, the drug can remain in the body for up to 18 hours, resulting in increased risk of drowsiness, disorientation and decline. This review also highlighted possible links between long-term diphenhydramine use and dementia.
In children, the risks can be even more pronounced. The review authors quote the case studies Paradoxical responses such as accidental overdose; agitating, extreme sedation, coma. And especially in pediatric preparations, death occurs due to accidental ingestion. The drug was associated with hospitalization and deaths of several children during the Tiktok virus “Benadril Challenge.”
Dr. Manuela Murray, director of general pediatrics and emergency medicine at the University of Texas Department of Medicine, said diphenhydramine should not be used lightly.
“It should always be used under the guidance of a medical professional and is shown only to treat allergic reactions and movement intoxication,” Murray wrote in an email.
Drug therapy is often misused and “is not a safe sleeping pill medicine that does not benefit treatment for cold symptoms,” she said. In fact, it can have the opposite effect on children, leading to hyperactivity.
Dr. Alyssa Kuban, pediatrician and associate medical director for Texas Pediatric Pediatrics, said he found that Diphenhydramine was overused because of symptoms that had no direct treatment and had a safer alternative.
“Some families who use diphenhydramine when their children have colds or upper respiratory tract infections believe it helps them with crowds and sleep at night,” she said. “This is not effective against cold symptoms and is very insecure.”
She recommends over-the-counter cetirizine to treat children with hives, seasonal allergies, or itchy rashes. Cetiridine also lasts longer, and is not as sedative as diphenhydramine, she says.
Murray agrees that loratadine and cetirizine are safer for children over six months, and saline drops and aspiration are better alternatives for babies.
Diphenhydramine appears in over 300 OTC formulations and is often mixed in combination with cough, cold and influenza. The authors of this review state that, like products containing pseudoephedrine, they need to move behind the counter with minimal diphenhydramine, allowing pharmacists to guide patients to second generation alternatives.
The American Association of Pharmacists says patients should pay attention to concomitant cough and cold products that contain diphenhydramine.
Pharmacists may recommend alternative medications to older people who have a history of being cognitively affected by certain medications. The group “encourages patients and parents/caregivers to ask patients and parents/caregivers to request the pharmacist for the most appropriate treatment recommendations for the amount of the lowest side effects.”
The review authors also emphasize that there is no strong clinical data to suggest that diphenhydramine works better than other options. It can reduce symptoms such as sneezing and itching, but it has minimal impact on nasal traffic jams and does not outweigh second-generation medications in randomized trials. New options such as oral cetirizine provide 24-hour coverage with fewer adverse events.
However, in the US, medicine remains a staple diet. Reviews show that over 1.5 million prescriptions are still written each year, not counting untracked OTC purchases.
“In the past, it has been a useful drug that has helped millions of patients, but the current treatment ratio is consistent or exceeded with second-generation antihistamines, particularly due to significant reductions in side effects.
