Place in therapy
Efficacy:
The efficacy of diphenhydramine has been established in several short term (1-2 weeks) randomized controlled trials in patients with mild to moderate insomnia.1 When compared to placebo, diphenhydramine has been shown to improve several sleep parameters such as sleep latency, frequency of awakening, wake time, sleep duration, and quality of sleep.2 Evidence based medicine does not support the use of diphenhydramine in chronic insomnia.3,4 If first line therapy with sleep hygiene practices is unsuccessful, diphenhydramine may be used as augmentation in mild-moderate insomnia. Duration of treatment should not exceed 1-2 weeks.
Safety:
Diphenhydramine should be avoided in geriatric patients due to significant anticholinergic side effects. It should also be avoided in pregnancy and lactation because it crosses the placenta and has been found in breast milk. Use during pregnancy has been linked to adverse fetal events such as respiratory depression and withdrawal symptoms. It is contraindicated in patients with glaucoma, benign prostatic hypertrophy, heart disease, constipation, dry mouth and dry eyes. If it is selected for use, it is important to counsel the patient on side effects such as morning drowsiness, dizziness and grogginess. 5,6
References
1. Clinical Practice Review Committee, American Academy of Sleep Medicine, Oral Nonprescription Treatment for Insomnia: An evaluation of Products with Limited Evidence. Journal of Clinical Sleep Medicine, Vol1, No.2, 2005
2. Rickels K, Morris R, Newman H, Rosenfeld H, Schiller H, Weinstock R. Diphenhydramine in insomniac family practice patients: a double-blind study. J Clin Pharmacol. 1983;23:235-42.
3. Schutte-Rodin Sharon, Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults, Journal of Clinical Sleep Medicine, Vol. 4, No. 5, 2008
4. Bonnet MH et al. Treatment of Insomnia. UpToDate, May 2012
5. Lexi-comp, Diphenhydramine Product Monograph, Retrieved July 10, 2012 from: http://online.lexi.com/lco/action/search?q=diphenhydramine&t=name
6. Canadian Pharmacists Association, Patient Self Care, 1st Edition
.
Efficacy:
The efficacy of diphenhydramine has been established in several short term (1-2 weeks) randomized controlled trials in patients with mild to moderate insomnia.1 When compared to placebo, diphenhydramine has been shown to improve several sleep parameters such as sleep latency, frequency of awakening, wake time, sleep duration, and quality of sleep.2 Evidence based medicine does not support the use of diphenhydramine in chronic insomnia.3,4 If first line therapy with sleep hygiene practices is unsuccessful, diphenhydramine may be used as augmentation in mild-moderate insomnia. Duration of treatment should not exceed 1-2 weeks.
Safety:
Diphenhydramine should be avoided in geriatric patients due to significant anticholinergic side effects. It should also be avoided in pregnancy and lactation because it crosses the placenta and has been found in breast milk. Use during pregnancy has been linked to adverse fetal events such as respiratory depression and withdrawal symptoms. It is contraindicated in patients with glaucoma, benign prostatic hypertrophy, heart disease, constipation, dry mouth and dry eyes. If it is selected for use, it is important to counsel the patient on side effects such as morning drowsiness, dizziness and grogginess. 5,6
References
1. Clinical Practice Review Committee, American Academy of Sleep Medicine, Oral Nonprescription Treatment for Insomnia: An evaluation of Products with Limited Evidence. Journal of Clinical Sleep Medicine, Vol1, No.2, 2005
2. Rickels K, Morris R, Newman H, Rosenfeld H, Schiller H, Weinstock R. Diphenhydramine in insomniac family practice patients: a double-blind study. J Clin Pharmacol. 1983;23:235-42.
3. Schutte-Rodin Sharon, Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults, Journal of Clinical Sleep Medicine, Vol. 4, No. 5, 2008
4. Bonnet MH et al. Treatment of Insomnia. UpToDate, May 2012
5. Lexi-comp, Diphenhydramine Product Monograph, Retrieved July 10, 2012 from: http://online.lexi.com/lco/action/search?q=diphenhydramine&t=name
6. Canadian Pharmacists Association, Patient Self Care, 1st Edition
.