For decades, diphenhydramine—best known by the brand name Benadryl—has been a go-to medication for relieving allergy symptoms, like itchy rashes, runny noses, and watery eyes. Not to mention helping users doze off to sleep while battling those allergy-related symptoms. But despite its brand-name presence over the decades, and despite many of us having it in our medicine cabinets right now, some experts say it’s time to stop using the popular drug.
The drug’s side effects and other risks are so concerning that it should no longer be readily available over the counter or widely prescribed, several doctors argued in a paper published in the World Allergy Organization Journal earlier this year titled “Diphenhydramine: It is time to say a final goodbye.”
Diphenhydramine is a first-generation antihistamine. It’s been around since the 1940s. Antihistamines block receptors called H1. These are part of how your body reacts to allergens, which are substances that can cause an allergic reaction in some people. When those receptors are triggered, you can get symptoms like sneezing, itching, and a runny nose.
Allergic reactions often trigger a release of histamine, which can cause symptoms like sneezing, itching in the nose and throat, coughing and hives. Blocking this chemical helps to calm allergy symptoms and make you sleepy.
“While Benadryl is widely used for allergies, it isn’t that helpful for colds or infections,” allergist and immunologist with Banner – University Medicine, Dr. Tara Carr, said.
Benadryl is convenient for allergy symptoms because it starts to work quickly, but the effects usually wear off after a few hours. “People who have ongoing allergy symptoms like a persistent rash or seasonal nasal allergies might need to take Benadryl four times a day to keep their symptoms under control,” Dr. Carr said.
It may not be safe or effective if you use it regularly. “Because diphenhydramine is an older drug, it isn’t targeted as precisely as some of our newer antihistamine options,” Dr. Carr said.
While diphenhydramine can help with sneezing and itching, older drugs like this one also affect other parts of the brain. They can make you very drowsy, slow your thinking, and, in some cases, cause dangerous heart problems.
What’s also concerning is that in older adults, diphenhydramine can stay in the body for up to 18 hours. That increases the risk of falls and disorientation. In children, it can cause extreme sleepiness, agitation, hyperactivity, accidental overdose, and, in rare cases, coma or even death.
The World Allergy Organization Journal also linked the allergy pill to poor school performance, saying that diphenhydramine was connected to “significant performance deficits on tests of divided attention, working memory, vigilance, and speed.”
A review led by allergy experts from Johns Hopkins University and the University of California, San Diego, is recommending that diphenhydramine be taken off the market, or at least moved behind the counter. That way, pharmacists can help guide people toward safer choices. What many people don’t realize is that diphenhydramine is in more than 300 over-the-counter products, often combined with medicines for coughs, colds, and flu. So, people may be taking it without realizing it.
Other doctors say the medication is often misused and doesn’t offer a benefit for the treatment of cold symptoms, and it is not a safe sleep aid medication. 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.”
“Patients should trial alternative 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.”
You should talk to your health care provider before using Benadryl if:
You are age 65 or older
You have memory problems or a family history of dementia
You have glaucoma, an enlarged prostate or heart issues
You are considering Benadryl for a child, since Benadryl is not recommended for children under 6 unless a provider suggests it
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