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Diphenhydramine: It is time to say a final goodbye
James H Clark1, Eli O Meltzer2, Robert M Naclerio1
1Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
The World Allergy Organization Journal
|February 10, 2025
Summary
Diphenhydramine, a first-generation antihistamine, poses greater public health risks than newer alternatives. Its use should be restricted due to a higher adverse effect profile, especially in children and the elderly.
Area of Science:
- Pharmacology
- Public Health
Background:
- Diphenhydramine was a pioneering antihistamine but is now surpassed by second-generation options.
- Second-generation antihistamines offer similar efficacy with improved safety profiles.
Purpose of the Study:
- To evaluate the current therapeutic ratio and public health implications of diphenhydramine.
- To assess the continued appropriateness of diphenhydramine's widespread availability.
Main Methods:
- Comprehensive evaluation of clinical practice patterns.
- Analysis of the prevalence and incidence of adverse clinical events associated with diphenhydramine.
Main Results:
- Diphenhydramine exhibits a problematic therapeutic ratio, with higher adverse effects in children and older adults.
- Despite risks, diphenhydramine is available in over 300 formulations, many over-the-counter.
Conclusions:
- Diphenhydramine has reached the end of its therapeutic life cycle.
- It represents a significant public health hazard compared to other antihistamines.
- Recommendations include restricting its prescription and over-the-counter availability.
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