Every pediatrician knows how useful diphenhydramine (DPH, common trade name Benadryl) can be for symptoms associated with allergies, eczema, and hives. Readily available OTC, adults buy it for sleep because of its drowsiness “side effect”, with many trade names and store brands (290 synonyms on PubChem).
It also appears on the respected “Beers Criteria“, which is an extensive list of meds to be avoided, published by the American Geriatric Society, based on the work of the late eminent geriatrician Mark Beers. This is an expert consensus guideline for medicating persons over age 65, and is evidently used in many nursing homes.
Starting about six months ago, my wife, not yet 65, started having “agitation”, and her sleep was even more disturbed. She’d been on chewable melatonin for years, and I think that did help in the beginning, but she started waking up several times a night, loud and seemingly disturbed. I was a nursing home orderly in my youth, and this didn’t seem like ordinary “sundowning” to me.
I’m not going to divulge details, but something else medical happened, and she eventually got both IV and oral meds, outpatient then inpatient for a week. The meds maybe helped her bit, but also left her with other (seemingly “iatrogenic”) problems. The most overt persistent problem consists of repetitive movements both day and night, a side effect I saw 40 years ago while a student on a psychiatric ward (which some now call tardive syndromes).
Back to DPH, there is a dementia connection. A number of studies, one by local respected dementia epidemiologists, found links between certain meds in the DPH category and subsequent long term cognitive problems. It’s well known these meds can make one “fuzzy” acutely, corroborated in an elderly rural population.
On the other hand, there a zillions of peer reviewed studies of DPH in kids and adults, for sleep, allergy, even nausea, and dealing with overdoses, in aggregate showing relative effectiveness and safety. There are not many recent studies about persons with dementia who have sleep or other issues like agitation, to see if DPH might help them, or whether it might worsen or accelerate the typical trajectory of those patients.
SO, I’m not going to give medical advice here, or details, but I am going to just write that some OTC meds come in liquid formulations (as pediatricians know) for easy titration, and might be really helpful. Like most everything else one cannot say these meds cure anything; they might help symptoms, but EVERYONE is AN INDIVIDUAL, right?
DISCLOSURE: I do not knowingly have any investments or financial ties in any drug companies of OTC products, although who knows what I have in retirement mutual funds. I was a pediatric oncologist, and daily confronted the issue of toxicity vs. efficacy, good effect vs. bad effects, and the consideration of long-term side effects, i.e. risk/reward with available agents that happened to have a low “therapeutic index:” chemotherapy. Here’s another question for you: isn’t Alzheimer’s a fatal disease?
