Stop prescribing Benadryl™ (S8 Ep. 54)

If you've been looking for a New Year's Resolution to make a real difference in your practice, stop prescribing diphenhydramine.  Despite being a common over-the-counter medication, its potent anticholinergic side effects and sedation make it a poor choice for children.  Review the common misuses for the drug and practical, evidence-based alternatives to help get diphenhydramine out of your prescribing practice in 2023.   References: Bachur RG, Monuteaux MC, Neuman MI. A comparison of acute treatment regimens for migraine in the emergency department. Pediatrics 2015;135:232-238. Brady, K.B. (2020). 'Benadryl challenge": What pediatricians need to know. AAP News. Retrieved from https://publications.aap.org/aapnews/news/6210/Benadryl-Challenge-What-pediatricians-need-to-know Chehab, H., Fischer, P. R., & Christenson, J. C. (2021). Preparing Children for International Travel. Pediatrics in Review, 42(4), 189–202. https://doi.org/10.1542/pir.2018-0353 Ghossein N, Kang M, Lakhkar AD. Anticholinergic Medications. [Updated 2022 May 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555893/ Green, J.L., Wang, G.S., Reynolds, K.M., Banner, W., Bond, G.R., Kauffman, R.E., Palmer, R.B., Paul, I.M., Dart, R.C. (2017). Safety profile of cough and cold medication use in pediatrics. Pediatrics, 139(6), e20163070. doi: 10.1542/peds.2016-3070 Guthrie, C.C., & Nathani, Y. (2019). Acute treatment of pediatric migraine. Pediatric Emergency Medicine Reports. Relias Media. Retrieved https://www.reliasmedia.com/articles/144150-acute-treatment-of-pediatric-migraine Palmer, R. B., Reynolds, K. M., Banner, W., Bond, G. R., Kauffman, R. E., Paul, I. M., Green, J. L., & Dart, R. C. (2020). Adverse events associated with diphenhydramine in children, 2008-2015. Clinical toxicology (Philadelphia, Pa.), 58(2), 99–106. https://doi.org/10.1080/15563650.2019.1609683 Paul, I.M., Yoder, K.E., Crowell, K.R., Shaffer, M.L., McMillan, H.S., Carlson, L.C., Dilworth, D.A., Berlin, C.M. (2004). Effect of dextromethorphan, diphenhydramine, and placebo on nocturnal cough and sleep quality for coughing children and their parents. Pediatrics, 114(1), e85-e90. doi: 10.1542/peds.114.1.e85 Shaker, M. S., Wallace, D. V., Golden, D. B. K., Oppenheimer, J., Bernstein, J. A., Campbell, R. L., Dinakar, C., Ellis, A., Greenhawt, M., Khan, D. A., Lang, D. M., Lang, E. S., Lieberman, J. A., Portnoy, J., Rank, M. A., Stukus, D. R., Wang, J., Collaborators, Riblet, N., Bobrownicki, A. M. P., … Wang, J. (2020). Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. The Journal of allergy and clinical immunology, 145(4), 1082–1123. https://doi.org/10.1016/j.jaci.2020.01.017 Stern J, Pozun A. Pediatric Procedural Sedation. [Updated 2022 Sep 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK572100/ Trottier ED, Bailey B, Lucas N, Lortie A. Prochlorperazine in children with migraine: A look at its effectiveness and rate of akathisia. Am J Emerg Med 2012;30:456-463