[4 min read]
In this article:
- Many of us regularly use diphenhydramine, best known as Benadryl, to treat our kids' allergies and cold symptoms.
- A Swedish pediatrics expert says it's time to think about options that are safer and have fewer serious side effects including sedation, impared speech and sleep patterns.
- Talk to your doctor about the best choice for your children and your family.
Imagine a medication that has a safety and efficacy profile with the following highlights: commercial air pilots cannot fly for at least 60 hours after a single dose; the European Union has added it to its “do not drive” category of medications; and countries such as Germany and Sweden restrict over-the-counter access for safety reasons. Now, imagine prescribing that medication to children, even infants, when there are safer and more effective alternatives. Yet, this is what clinicians do across the U.S. every day.
“Physicians and advanced practice clinicians write more than 1.5 million prescriptions for this drug each year and make countless more recommendations for one of its 300 formulations that are available over-the-counter,” says Providence Swedish pediatrician Elizabeth Meade, M.D. “We continue to use diphenhydramine, which is probably best known as one of its brand names, Benadryl.”
“The drug is prescribed or used by parents reflexively for everything from seasonal allergies to eczema—despite overwhelming evidence supporting newer antihistamines as safer, more effective and better aligned with physicians’ commitment to patient-centered care,” Dr. Meade adds.
Diphenhydramine has been available for decades; it’s familiar, inexpensive and readily available. Parents and clinicians are accustomed to its use, even without a clinically indicated reason. How many parents have had someone recommend that they “just give a little Benadryl®” before a flight with their toddler or a long car trip? And even side effects—sedation and dry mucus membranes—are sometimes equated with effectiveness. In truth, there’s shockingly little evidence to support use for just any indication.
First-generation antihistamines like diphenhydramine cross the blood-brain barrier and lead to significant sedation and impaired thoughts, actions and speech. (Physicians and clinicians call this psychomotor impairment.) Side effects of the drug include drowsiness, altered sleep patterns and even lingering confusion and motor skill effects that far outlast antihistamine benefits.
“Some children — up to 10-15% of kids, even if they haven’t reacted that way to past doses — will experience a hyperactivity reaction. Other potential side effects include blurry vision or dry eyes, cardiac effects, dry mouth, constipation, and urinary retention. Its onset and duration of action are unpredictable,” says Dr. Meade. “And, typically the duration of action is only a few hours—as short as 4 hours in young children—requiring frequent dosing and compounded lingering side effects Why are we using this medication at all?”
In the past, a lack of alternatives led to the regular recommendation and prescription of diphenhydramine, even hospitals, but now there are safer, more effective, longer-lasting antihistamines such as cetirizine (which is sold under the brand name Zyrtec) or loratadine (sold as Claritin or Alavert) which have far fewer psychomotor side effects. Others, such as fexofenadine (most commonly sold as the brand name Allegra), have none at all.
“These drugs are well-studied in pediatric populations, including in infants, and have far superior safety profiles. In addition to being safer, they have faster onset and longer duration, typically with once-daily dosing,” says Dr. Meade. “This in itself is a win for anyone trying to get medication into a stubborn child! And because symptoms aren’t masked by sedation, physicians and clinicians can get a truer sense of how the medications are working and what children are feeling. This helps us develop the best and most effective care plans for our patients."
What should we do now? First, says Dr. Meade, we should all go home and throw away any diphenhydramine in our medicine cabinets. She also thinks it’s critically important that doctors’ use their voices to educate families in the broader community about why sedating antihistamines are outdated and even dangerous.
“Families should talk with their doctors and clinicians about this and ask questions,” says Dr. Meade. “There is no longer any indication for using diphenhydramine in children. It’s time to say goodbye!”
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