Posted on 08/05/2025 7:41:16 AM PDT by Red Badger
Dr. Anna Wolfson says she sees dangerous misuse of the allergy medication diphenhydramine in her clinic every day.
“If someone has an allergic reaction to a food, people will say, ‘Don’t worry, I have diphenhydramine in my purse,’ and I would say, ‘Really, epinephrine is the first-line treatment for food allergies,’” said Wolfson, an allergist at Massachusetts General Hospital.
Diphenhydramine can be harmful if people take it after having an allergic reaction to food, she said, because the drug – best known by the brand name Benadryl – makes them drowsy and can cause them to miss signs that their symptoms are getting worse.
“It’s time to move on. For every single indication that people are using diphenhydramine, there are better drugs that are more effective at treating the symptoms people are trying to treat with fewer side effects,” she said. “I’ve had patients where I worried that diphenhydramine was impairing their ability to drive or fully participate in their daily lives.”
Wolfson isn’t alone in preferring alternatives. In a review published in February, allergy experts from Johns Hopkins University and the University of California, San Diego called for the removal of diphenhydramine from over-the-counter and prescription markets in the United States, saying it’s outdated, dangerous and eclipsed by safer alternatives.
A first-generation antihistamine approved in 1946, diphenhydramine is widely used for allergies, sleep aid and cold symptoms. It’s a common over-the-counter medication in the US, with usage rising in the summer months as people use it to treat itching from bug bites or poison ivy, as well as sneezing and runny nose caused by grass and pollen allergies, according to the American Pharmacists Association.
Despite its longstanding presence in American homes, the authors of the new review say it poses disproportionate risks, especially for children and older adults, than newer antihistamines.
“Patients should trial alternatives agents like loratadine, which is Claritin, or cetirizine, which is Zyrtec, or fexofenadine, which is Allegra,” to alleviate allergy symptoms, Dr. James Clark of the Department of Otolaryngology-Head and Neck Surgery at the Johns Hopkins University School of Medicine, the lead author of the paper, told CNN.
The Consumer Healthcare Products Association, which represents the OTC medicine industry, says that common side effects associated with products containing diphenhydramine are disclosed on the label. However, it notes, “these products are not intended for long-term use.”
“When used as directed, these medicines provide well-established therapeutic benefits for common health ailments like allergies, the common cold, motion sickness, minor skin irritations, and occasional sleeplessness,” the group said in a statement on behalf of Benadryl’s maker, Kenvue. “Like all medicines, responsible use is essential, and consumers should always follow directions and warnings on the Drug Facts labels and consult healthcare providers if they have questions.”
Risks of diphenhydramine
Antihistamines work by blocking receptors called H1, part of the body’s system for responding to allergens, which trigger symptoms like sneezing, itching and a runny nose. But older drugs like diphenhydramine don’t just block the 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 wrote.
In older adults, the drug can stay in the body for up to 18 hours, resulting in lingering sleepiness, disorientation and increasing risk of falling. The review also highlighted a possible link between long-term diphenhydramine use and dementia.
In children, the risks can be even more pronounced. The review’s authors cite cases of accidental overdose; paradoxical reactions such as agitation, extreme sedation and coma; and even death, particularly with pediatric formulations, because of accidental ingestions. The medication was linked to several child hospitalizations and fatalities during the viral “Benadryl Challenge” on TikTok.
Dr. Manuela Murray, director of general pediatrics and urgent care at the University of Texas Medical Branch, says diphenhydramine “should not be used lightly.”
“It should always be used under the guidance of a Medical Professional, and it is only indicated to treat allergic reactions and motion sickness,” Murray wrote in an email.
The medication is often misused and “doesn’t offer a benefit for treatment of cold symptoms, and it is not a safe sleep aid medication,” she said. In fact, it can have the opposite effects in children, leading to hyperactivity.
Dr. Alyssa Kuban, a pediatrician and associate medical director at Texas Children’s Pediatrics, also said that she finds diphenhydramine overused for symptoms it does not directly treat and that there are safer alternatives.
“I see some families use diphenhydramine when the child has a cold or upper respiratory infection, thinking it will help with the congestion and help them to sleep better at night,” she said. “This is not effective for cold symptoms, nor is it very safe.”
She recommends over-the-counter cetirizine to treat children with hives, seasonal allergies or an itchy rash. Cetirizine is also longer-lasting and not as sedating as diphenhydramine, she says.
Murray agrees that loratadine and cetirizine are safer for children over 6 months, and saline drops and suctioning are better alternatives for infants.
‘Time to say a final goodbye’
Diphenhydramine appears in over 300 OTC formulations, often blended into combination products for coughs, colds and flu. The authors of the review say that, like products with pseudoephedrine, diphenhydramine should at minimum be moved behind the counter, allowing pharmacists to guide patients toward second-generation alternatives.
The American Pharmacists Association says patients should use caution with combination cough and cold products that contain diphenhydramine.
Pharmacists may recommend alternative medications for older adults who have a history of being cognitively affected by certain medications, the group says, and it “encourages patients and parents/caregivers to ask their pharmacist for the most appropriate treatment recommendation for their symptoms” with the least amount of side effects.
The review authors also emphasize that there is no strong clinical data that may suggest that diphenhydramine works better than other options. Although it may reduce symptoms like sneezing and itching, it has minimal effect on nasal congestion and doesn’t outperform second-generation drugs in randomized trials. Newer options, such as oral cetirizine, offer 24-hour coverage with fewer adverse events.
However, in the US, the medication remains a staple. According to the review, more than 1.5 million prescriptions are still written annually, not counting untracked OTC purchases.
“In the past, it has been a useful medication that has helped millions of patients; however, its current therapeutic ratio is matched or exceeded by second-generation antihistamines, especially due to their markedly reduced adverse reactions. It is time to say a final goodbye to diphenhydramine, a public health hazard,” the authors wrote.
Have to considered seeing an allergist?
Mine performed the skin prick test on me, determined what my allergies were and set up an injection therapy targeting those particular irritants.
Yes, it took 3 years of injections once a month, but now during allergy season I have nearly zero issues.
For me it was worth the time and my insurance picked up everything but a small copay per visit.
I don't have any pseudoephedrine in my house anymore. I do have 250 count bottles of diphenhydramine from Costco. I take 2 a bedtime. Absent the diphenhydramine, my eyes itch and water and sinuses feel "bruised". It makes sleeping very difficult. It is probably a consequence of the pet hair in my home. 5 dogs and a cat.
benedryl works and is cheap. I’m sure Big Pharma can cook up something that works the same for 5 times the price.
That is the real issue.
It’s expired patent doesn’t make them any money, so it has to be banned.
Kinda like Freon...................
I stopped using Benadryl when I found out it increases the risk of dementia.
Well, yeah. Everything’s a tradeoff in some way. I take one medication regularly because I consider the benefit to me to be more than the risk from side effects. On the other hand, I decided that the various SARS-CoV-2 vaccines presented more risk than benefit, so I didn’t take any of them.
Everyone does risk-benefit calculations all the time. The more information we have, the better.
Again, DAILY USE for things like “’just to sleep” obviously could lead to that...but occasional or as needed, it shouldn’t be discounted outright due to the aforementioned abuses otherwise.
“”I have to ask myself why the “health community” — for whom I have already lost a ton of respect — are on a jihad against Benadryl? Did the patent run out? Is it, like Ivermectin, too “safe and effective” but insufficiently profitable?
Been using diphenhydramine occasionally for decades. Only when needed. Works for me!””
The answer to your question is obvious. Because it works. It’s affordable. It’s OTC. It’s got to go! Replaced with a more expensive, prescription-only medication (docs working in tandem with Big Pharma) that doesn’t particularly work.
Did that the whole time I was a kid. It’s something very occasional now. Not something I really care about the four times a year it hits.
Nonsense
Utter crap
It is a good secondary helper for a stronger primary med like Singular. I take 10 mg 2x ad day and in bad flare up have taken three. I have life long 68 years of sinus allergies which had wreaked havoc on my Inner Ears and brain aka the Central Sensory Processing System. I take it and Singular. I also use immunity therapy aka allergy shots three shots ever three weeks. I was my Allergist first three Shot patient.
Any pill can have adverse reactions to a low percentage of the population. As of late policies have been aimed at taking meds away which helped people because of the very low percentage patients who can not take it.
Thanks to my Auditory and Vestibular Central Sensory Processing Damage including what is called Functional Myoclonic Jerks {Seizures} I take another drug very high on the elimination zealots list called Xanax. I have taken .5mg at 4 X daily since 1993 and in the past 4 years have started being treated like a common criminal even by my primary care doctor. It is a fact Xanax is abused usually by heavy drinkers. So they are using this as the reason to nearly eliminate it's usage but will hand out SSRI's like candy with zero patient education to a very dangerous possible adverse reaction called Serotonin Syndrome with the symptoms are similar to that of LSD. Again a very low percentage can have this reaction. Ironically the antidote is Xanax Ativan, or Valium, to stop the reaction.
It also advances dementia if you use it for a long period.
Same here, because I work rotating shift work, helps me get turned around.
Everyone does risk-benefit calculations all the time.
Not everyone, which is my point. Our education system, our society teaches that the free lunch exists.
No, everyone considers risks and benefits in every decision they make, however trivial or informal. You are right, though, that far too many people base their decisions on incomplete or outright false information, much of it gotten through the education system and through media.
Why the bait and switch?
Lede refers to using alternatives for food allergy indtances, then drops no alternative, just moves on to alternatives for seasonal stuff.
That’s why benedryl is continued. No alternative. Everything else requires an expensive doctor visit.
AI Overview
Several reports indicate a push to re-evaluate the availability and use of diphenhydramine, the active ingredient in Benadryl, especially for long-term or high-dose use. However, there is no current move to completely remove diphenhydramine from the market in the U.S..
Here’s a breakdown of the discussions and concerns surrounding Benadryl:
1. Concerns about diphenhydramine’s safety and effectiveness
Diphenhydramine is a first-generation antihistamine known to cause sedation and cross the blood-brain barrier.
Studies suggest a potential link between long-term use, particularly in older adults, and an increased risk of cognitive decline, including dementia.
Overdosing on diphenhydramine can lead to serious adverse effects like heart problems, seizures, coma, or even death.
Some healthcare professionals consider it outdated compared to newer, less-sedating antihistamines like Claritin (loratadine) and Zyrtec (cetirizine).
2. Calls for removing Benadryl from over-the-counter sales
Some argue that Benadryl should be available only with a prescription due to its potential for abuse and the availability of safer alternatives, according to Forbes.
In some jurisdictions outside the U.S., such as Germany, the Netherlands, and Sweden, Benadryl is already a prescription-only medication.
3. FDA actions and recalls
The FDA has warned against the dangers of taking higher than recommended doses of Benadryl, especially due to misuse trends like the “Benadryl Challenge” on social media.
The FDA has proposed ending the use of oral phenylephrine, a decongestant found in some Benadryl products, because it was found to be ineffective as a nasal decongestant when taken orally.
In March 2025, some liquid Benadryl products were recalled due to lacking child-resistant packaging, posing a child poisoning risk.
4. Current status in the U.S
Despite these concerns and recalls, diphenhydramine-containing Benadryl remains available over-the-counter in the U.S.
However, healthcare providers and pharmacists may recommend alternative, less-sedating antihistamines, especially for older adults or individuals with certain health conditions.
In summary, while Benadryl faces scrutiny regarding its safety and effectiveness, especially with long-term or high-dose use, it is not currently being removed from the market in the U.S. The emphasis is on promoting responsible use, exploring safer alternatives, and addressing specific product-related issues like packaging concerns.
has been unpatented practically forever
this child is stupid and without critical thinking skills and wanting to make a name.
smart
there is a concern over consistent diphenhydramine use and earlier onset of Alzheimer’s.
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