Pharma chemist here (and huge former Benadryl-taker due to growing up in the 70s/80s with massive poorly treated allergies and asthma). The research about Benadryl and Alzheimers is quite interesting, but I think it's raising a lot more questions than it answers right now. This is a correlative relationship and not a causative one (for now).
We have also been able to correlate high inflammatory markers with dementia/Alzheimer's. People with some chronic illnesses or allergies are likely to have chronically higher inflammatory markers as well. So it may not be Benadryl causing the Alzheimers, but the underlying inflammatory issue that inspires the Benadryl treatment.
To be fair, I do think Benadryl is a terrible idea for a sleep aid and I wish it wasn't sold as one.
But for allergies, I think it's too early to know for certain. If the newer antihistamines work for people, that's fantastic and ideal, but I don't want to scare people into thinking Benadryl is going to give them Alzheimer's.
Personally, I have found that Zyrtec & friends can work very well if my symptoms are mild. But sometimes they don't have any impact on more severe symptoms and I need Benadryl. (I am adding this not to start any arguments or provide medical advice, but to validate anyone who reads this and feels like something is "wrong" with them because they have similar experiences. I know I am not alone and it can be really concerning to feel like I'm doing something wrong by doing what I need to do to stay out of the hospital.)
This is such an interesting answer. My allergist used to give me Benadryl in his office if I reacted to my allergy shot. He said it works really quickly so was best for acute reactions vs Claritin that worked better at creating a steady response. Made sense to me, but I am not a scientist. Also, I'm wondering if you or Dr Rubin know if the issues with Benadryl also apply to Hydroxizine as another 1st gen antihistamine?
My allergist said the same thing, but this was about 10 years ago (I'm currently living in a rural area and don't have steady access to healthcare), so I'm curious if there's better data now? There's just so much more to be learned about these meds!
It's my understanding that the studies about dementia have been specific to diphenhydramine (Benadryl) so I'm really not sure about hydroxyzine. Hydroxyzine has less of an affinity for acetylcholine receptors, so it probably shouldn't have the same impact as Benadryl, but I really don't know and I'm really just making an educated guess.
I hope Dr. Rubin chimes in, and doesn't mind that I replied with speculations!
Prior to retiring, I was the nurse educator for The Mast Cell Disease Society. Our medical advisory board members were several allergists and immunologists in the US and abroad. I was instructed to educate our patients exactly as you described Dr. Rubin. Benadryl was reserved for emergent situations that required IV (intravenous) administration of antihistamines. One of our board members recommended Claritin Reditabs, since they dissolve so quickly and don’t require water to take. We also advised patients they could take the less expensive generic version. I appreciate your education.
As a mast cell disease patient, I have actually been on IV ceterizine in the past and also have had IV Benadryl. I am currently on a continuous Benadryl infusion. Having had both, I have found that IV Benadryl helps relieve my anaphylactoid symptoms better and quicker than IV ceterizine, but I find IV ceterizine works well as a maintenance type H1 for my treatment plan. I am not currently on it because we decided to rotate my H1 blockers, but I need to rotate them again, so we may be fighting for IV ceterizine again because I am trying to get off the continuous infusion and get on just pushes of IV Benadryl. But this is a personal experience.
Thanks, Dr. Rubin, for this information! Benadryl is commonly used in the migraine community in a migraine cocktail. This can be taken orally at home as a migraine abortive or in hospital intravenously, if needed. I haven't gotten to speak to my neurologist about this yet, but I wonder if there are other antihistamines that are now recommended for the migraine cocktail. Unfortunately I can't seem to find any guidance on this.
About 20 year ago, I had a bad case of poison ivy. A coworker suggested Benadryl gel for my itchiness. It helped, but it came with an unintended problem. Withdrawal symptoms of all things. From the diphenhydramine. My doctor concluded that it was best that I never use anything containing the drug again. And as luck would have it, I have seasonal allergies. I tried Claritin, but oddly it gave me some super realistic and weird dreams. Is this a symptom? I went back to a drug my mother gave me as a child - chlorpheniramine. I use the generic form but I remember it being called Chlor-Trimeton back in the 80s. Does the trick.
Does this then also apply to other first-generation antihistamines such as doxylamine succinate? Since it’s also sold as a sleep aid like unisom and some nighttime cold and flu medications, should it have the same warnings?
I had a physician tell me to take Benadryl if I were to be bitten by a honey bee since I have a mild allergy to them. Would any of the newer medications work for this?
I was told the same thing. I am highly to mosquitoes and have an EpiPen. An allergist told me to take Benadryl liquid because my throat starts to close.
Each time I see your posts about Benadryl, I feel more confused and worried than informed. If the potential risk of Benadryl is due to its anticholinergic properties, does that mean we are to be concerned about all medications that are anticholinergic? There are lots. Is the risk of taking doxylamine and cyproheptadine the same? What about drugs that are not typically prescribed for their antihistamine properties like the antidepressant amitriptyline or muscle relaxer cyclobenzaprine?
I was shocked when my kids prepped for overnight camp with their 5th grade class and the nurse told parents "you need a medication release form even if your kid takes Benadryl for sleep." I had no idea this was a thing.
Anaphalactic here. I only use benadryl when I start to experience anaphalactic issues: racing heart, breathing issues, dizziness, feeling like I'm going to pass out.
AND i ALWAYS hv to reminf anaesthesiologists to NOT add a benadryl dose post surgically- it keeps me up for hours! Gr8 article. Thank you
This is interesting and something I plan to discuss with my son's allergist this month. He seemed to be having an allergic reaction one morning and I couldn't find his Benadryl so I grabbed the Zyrtec and it worked just fine! Urgent care gave me the side eye and didn't believe he had been having an allergic reaction when I brought him in to make sure no further action was needed. I have no idea what caused his allergic reaction (possibly a delayed reaction, we suspected a food exposure) but I know the Zyrtec worked really well, really fast.
Pharma chemist here (and huge former Benadryl-taker due to growing up in the 70s/80s with massive poorly treated allergies and asthma). The research about Benadryl and Alzheimers is quite interesting, but I think it's raising a lot more questions than it answers right now. This is a correlative relationship and not a causative one (for now).
We have also been able to correlate high inflammatory markers with dementia/Alzheimer's. People with some chronic illnesses or allergies are likely to have chronically higher inflammatory markers as well. So it may not be Benadryl causing the Alzheimers, but the underlying inflammatory issue that inspires the Benadryl treatment.
To be fair, I do think Benadryl is a terrible idea for a sleep aid and I wish it wasn't sold as one.
But for allergies, I think it's too early to know for certain. If the newer antihistamines work for people, that's fantastic and ideal, but I don't want to scare people into thinking Benadryl is going to give them Alzheimer's.
Personally, I have found that Zyrtec & friends can work very well if my symptoms are mild. But sometimes they don't have any impact on more severe symptoms and I need Benadryl. (I am adding this not to start any arguments or provide medical advice, but to validate anyone who reads this and feels like something is "wrong" with them because they have similar experiences. I know I am not alone and it can be really concerning to feel like I'm doing something wrong by doing what I need to do to stay out of the hospital.)
This is such an interesting answer. My allergist used to give me Benadryl in his office if I reacted to my allergy shot. He said it works really quickly so was best for acute reactions vs Claritin that worked better at creating a steady response. Made sense to me, but I am not a scientist. Also, I'm wondering if you or Dr Rubin know if the issues with Benadryl also apply to Hydroxizine as another 1st gen antihistamine?
My allergist said the same thing, but this was about 10 years ago (I'm currently living in a rural area and don't have steady access to healthcare), so I'm curious if there's better data now? There's just so much more to be learned about these meds!
It's my understanding that the studies about dementia have been specific to diphenhydramine (Benadryl) so I'm really not sure about hydroxyzine. Hydroxyzine has less of an affinity for acetylcholine receptors, so it probably shouldn't have the same impact as Benadryl, but I really don't know and I'm really just making an educated guess.
I hope Dr. Rubin chimes in, and doesn't mind that I replied with speculations!
Thanks so much for replying. Substack is filled with such kind people. and I'd also love to hear Dr Rubin's thoughts, maybe whilst hula hooping.
Prior to retiring, I was the nurse educator for The Mast Cell Disease Society. Our medical advisory board members were several allergists and immunologists in the US and abroad. I was instructed to educate our patients exactly as you described Dr. Rubin. Benadryl was reserved for emergent situations that required IV (intravenous) administration of antihistamines. One of our board members recommended Claritin Reditabs, since they dissolve so quickly and don’t require water to take. We also advised patients they could take the less expensive generic version. I appreciate your education.
As a mast cell disease patient, I have actually been on IV ceterizine in the past and also have had IV Benadryl. I am currently on a continuous Benadryl infusion. Having had both, I have found that IV Benadryl helps relieve my anaphylactoid symptoms better and quicker than IV ceterizine, but I find IV ceterizine works well as a maintenance type H1 for my treatment plan. I am not currently on it because we decided to rotate my H1 blockers, but I need to rotate them again, so we may be fighting for IV ceterizine again because I am trying to get off the continuous infusion and get on just pushes of IV Benadryl. But this is a personal experience.
Thanks, Dr. Rubin, for this information! Benadryl is commonly used in the migraine community in a migraine cocktail. This can be taken orally at home as a migraine abortive or in hospital intravenously, if needed. I haven't gotten to speak to my neurologist about this yet, but I wonder if there are other antihistamines that are now recommended for the migraine cocktail. Unfortunately I can't seem to find any guidance on this.
About 20 year ago, I had a bad case of poison ivy. A coworker suggested Benadryl gel for my itchiness. It helped, but it came with an unintended problem. Withdrawal symptoms of all things. From the diphenhydramine. My doctor concluded that it was best that I never use anything containing the drug again. And as luck would have it, I have seasonal allergies. I tried Claritin, but oddly it gave me some super realistic and weird dreams. Is this a symptom? I went back to a drug my mother gave me as a child - chlorpheniramine. I use the generic form but I remember it being called Chlor-Trimeton back in the 80s. Does the trick.
Serious question: is there an antihistamine other than Benadryl that will help you sleep without the issues you have highlighted?
Does this then also apply to other first-generation antihistamines such as doxylamine succinate? Since it’s also sold as a sleep aid like unisom and some nighttime cold and flu medications, should it have the same warnings?
I’m a school nurse and I’ve notice more and more orders come in for Claritin/Zyrtec instead of Benadryl. Great analysis! Thank you Dr Rubin.
I had a physician tell me to take Benadryl if I were to be bitten by a honey bee since I have a mild allergy to them. Would any of the newer medications work for this?
I was told the same thing. I am highly to mosquitoes and have an EpiPen. An allergist told me to take Benadryl liquid because my throat starts to close.
Each time I see your posts about Benadryl, I feel more confused and worried than informed. If the potential risk of Benadryl is due to its anticholinergic properties, does that mean we are to be concerned about all medications that are anticholinergic? There are lots. Is the risk of taking doxylamine and cyproheptadine the same? What about drugs that are not typically prescribed for their antihistamine properties like the antidepressant amitriptyline or muscle relaxer cyclobenzaprine?
So what are better sleep meds that you recommend?
My experience with 2nd generation antihistamines is a no go. They just don't work.
My body reacts better to old school drugs than anything new.
They don’t work for me either. I keep giving them a try but still end up needing to add in Benadryl to deal with my symptoms. So frustrating!
TylenolPM is also diphenhydramine, a lot of it.
I was shocked when my kids prepped for overnight camp with their 5th grade class and the nurse told parents "you need a medication release form even if your kid takes Benadryl for sleep." I had no idea this was a thing.
Anaphalactic here. I only use benadryl when I start to experience anaphalactic issues: racing heart, breathing issues, dizziness, feeling like I'm going to pass out.
AND i ALWAYS hv to reminf anaesthesiologists to NOT add a benadryl dose post surgically- it keeps me up for hours! Gr8 article. Thank you
It's also the only topical antihistamine I've been able to find. Cortizone tends to mess with my sleep, so it's a go-to for rashes.
This is interesting and something I plan to discuss with my son's allergist this month. He seemed to be having an allergic reaction one morning and I couldn't find his Benadryl so I grabbed the Zyrtec and it worked just fine! Urgent care gave me the side eye and didn't believe he had been having an allergic reaction when I brought him in to make sure no further action was needed. I have no idea what caused his allergic reaction (possibly a delayed reaction, we suspected a food exposure) but I know the Zyrtec worked really well, really fast.