The Dangers of Benadryl

I enjoyed a social evening with a respected colleague who is one of my closest friends.  He and his wife are great conversationalists, and during the course of the dinner he wondered about the dangers of Benadryl (diphenhydramine) in precipitating dementia.

This is a responsible practitioner who delights in keeping up on developments in the field … but I can’t say that about all of my colleagues.  Therefore, his question was a valid one. A lot of (alarmist) popular health newsletters have picked up on this topic and are spreading some very alarming warnings. Of course, I had to find the original study because often the general opinions stated by such articles are — shall we say — somewhat alarmist. In order to get published and carry authority, people are publishing from large databases.  In this case, pooling the prescription data on multiple anticholinergic drugs — all at, by definition, prescription strengths.  Benadryl is far and away the LEAST anticholinergic drug studied — and plenty of folks (like me and my dinner colleague) would not even think of giving it chronically at prescription strength (you have to crank up the dose for efficacy and then, hoo-boy, do you get side effects).  Benadryl is a very mild agonist of multiple different receptors.  Still pretty benign at low doses, but it has been around for a long time.  Actually, I think the most dangerous (and the most anticholinergic) drug they looked at was doxepin. (Sinequan) 25 mg (although 10 mg. and even 5 mg. have been shown to work for sleep).  This drug-drug interactions and anticholinergic side effects. One of those is sleepiness, and there are plenty of general practitioners (meaning “non-specialists) giving this to patients for sleep.  Well-meaning doctors, but they are giving this to people who have other prescriptions for other conditions and because of the drug interactions mentioned already, they can cause bad side effects.  This is usually done by doctors who have been practicing for a while, who don’t necessarily keep up with the current literature, and who are pressed for time by a system that just tells them to pile more drugs on whenever a patient complains.  I usually taper people off this medicine, and never would even think of keeping it without a review of their other medications for drug-drug interactions.  People actually need to be tapered, because at this dose they can get “withdrawals,” which while not deadly, do include nauseate and can cause a pretty bad headache. Anticholinergics (like Doxepin) have made people crazy for a long time, and can cause acute delirium, let alone dementia.  I have no problem combining 25 or 50 mg. of Benadryl with 3 to 6 of melatonin.  I would use it myself, which is my gold standard for medical recommendations.  There is more to being a doctor than just having a license to prescribe medications, but our current health system bypasses specialists (such as psychiatrists) regularly in that all-encompassing quest to cut costs.  Sometimes, it can cut a patient’s life short … and this is why I say that I think “care” has disappeared from “healthcare.”  But then, I am the one accused of being alarmist. I can only answer, “Mea culpa!” Happy 4th of July and be safe and happy!