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1.
Sr Care Pharm ; 35(3): 113-119, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32070459

RESUMO

A 62-year-old patient living in a rural community was referred to participate in a pharmacist-led home visit program because of concerns with the patient's increasing falls and medication complexity. The patient reported experiencing an increasing number of falls over the past few months, resulting in a recent hospitalization and mild head trauma. The patient's past medical history included diabetes mellitus type 2, hypertension, hyperlipidemia, gastroesophageal reflux disease, paroxysmal atrial fibrillation, unspecified back pain, and benign prostatic hyperplasia. During the comprehensive medication review, pharmacists determined the patient had inadvertently purchased an acetaminophen/ diphenhydramine combination medication, rather than his usual acetaminophen. According to the 2019 Beers criteria, use of acetaminophen/diphenhydramine for back pain without insomnia is not the best option and may contribute to falls. With an estimated four to eight tablets per day, the patient was taking 200-400 mg of diphenhydramine daily. Pharmacist recommendations included contacting the prescribing physician to obtain a prescription for acetaminophen. By asking the local pharmacy to dispense acetaminophen as a prescription, the risk of the patient inadvertently purchasing an inappropriate product is reduced. After removing the diphenhydramine from the patient's regimen, the falls ceased. This case demonstrates the effects of inappropriate diphenhydramine use in an especially vulnerable population. It also highlights the critical role that rural community pharmacists can play in improving their patients' health care.


Assuntos
Difenidramina/efeitos adversos , Humanos , Pessoa de Meia-Idade , Assistência Farmacêutica , Lista de Medicamentos Potencialmente Inapropriados
2.
Am J Case Rep ; 20: 758-763, 2019 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-31138776

RESUMO

BACKGROUND Diphenhydramine is a commonly available over-the-counter antihistamine; however, there are few documented cases of treatment when ingested in toxic quantities, where it can cause a sodium channel blockade leading to wide-complex tachycardia, seizures, and death. Conventional treatment includes sodium bicarbonate infusion, but few cases have documented the addition of lipid emulsion therapy. CASE REPORT A 24-year-old African American female ingested 18 g (360 pills of 50 mg) over-the-counter diphenhydramine. She presented comatose, with hemodynamic instability and hypotension, intubated with pupil dilation to 6 to 7 mm, and initial electrocardiography findings showing a type 1 AV block with a QT/QTc of 360/402 ms which progressed into sinus tachycardia with widened QRS intervals of 134 ms and prolonged QT/QTc intervals of up to 638/759 ms. Treatment using sodium bicarbonate and magnesium was initiated; however, the intraventricular conduction delay persisted. Infusion of 20% intravenous lipid emulsion was administered; following this, the patient developed narrow complex QRS with sinus rhythm and shortened the QT/QTc interval to 448/516 ms. She recovered quickly and was transferred to inpatient psychiatric unit for further evaluation, and discharged 1 month later. CONCLUSIONS Lipid emulsion therapy has been utilized in treatment of various medication overdoses, but there are few documented cases in the treatment of diphenhydramine overdose. With the amount of diphenhydramine ingested by the patient in this case report, the use of combined conventional and lipid emulsion therapy was utilized in the stabilization and management of the patient, and should be considered in scenarios where conventional treatments have not improved the clinical outcome.


Assuntos
Arritmias Cardíacas/induzido quimicamente , Arritmias Cardíacas/terapia , Difenidramina/efeitos adversos , Overdose de Drogas/terapia , Emulsões Gordurosas Intravenosas/uso terapêutico , Antagonistas dos Receptores Histamínicos H1/efeitos adversos , Feminino , Humanos , Adulto Jovem
3.
JAMA ; 321(15): 1481-1490, 2019 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-30990550

RESUMO

Importance: Oral mucositis causes substantial morbidity during head and neck radiotherapy. In a randomized study, doxepin mouthwash was shown to reduce oral mucositis-related pain. A common mouthwash comprising diphenhydramine-lidocaine-antacid is also widely used. Objective: To evaluate the effect of doxepin mouthwash or diphenhydramine-lidocaine-antacid mouthwash for the treatment of oral mucositis-related pain. Design, Setting, and Participants: A phase 3 randomized trial was conducted from November 1, 2014, to May 16, 2016, at 30 US institutions and included 275 patients who underwent definitive head and neck radiotherapy, had an oral mucositis pain score of 4 points or greater (scale, 0-10), and were followed up for a maximum of 28 days. Interventions: Ninety-two patients were randomized to doxepin mouthwash (25 mg/5 mL water); 91 patients to diphenhydramine-lidocaine-antacid; and 92 patients to placebo. Main Outcome and Measures: The primary end point was total oral mucositis pain reduction (defined by the area under the curve and adjusted for baseline pain score) during the 4 hours after a single dose of doxepin mouthwash or diphenhydramine-lidocaine-antacid mouthwash compared with a single dose of placebo. The minimal clinically important difference was a 3.5-point change. The secondary end points included drowsiness, unpleasant taste, and stinging or burning. All scales ranged from 0 (best) to 10 (worst). Results: Among the 275 patients randomized (median age, 61 years; 58 [21%] women), 227 (83%) completed treatment per protocol. Mucositis pain during the first 4 hours decreased by 11.6 points in the doxepin mouthwash group, by 11.7 points in the diphenhydramine-lidocaine-antacid mouthwash group, and by 8.7 points in the placebo group. The between-group difference was 2.9 points (95% CI, 0.2-6.0; P = .02) for doxepin mouthwash vs placebo and 3.0 points (95% CI, 0.1-5.9; P = .004) for diphenhydramine-lidocaine-antacid mouthwash vs placebo. More drowsiness was reported with doxepin mouthwash vs placebo (by 1.5 points [95% CI, 0-4.0]; P = .03), unpleasant taste (by 1.5 points [95% CI, 0-3.0]; P = .002), and stinging or burning (by 4.0 points [95% CI, 2.5-5.0]; P < .001). Maximum grade 3 adverse events for the doxepin mouthwash occurred in 3 patients (4%); diphenhydramine-lidocaine-antacid mouthwash, 3 (4%); and placebo, 2 (2%). Fatigue was reported by 5 patients (6%) in the doxepin mouthwash group and no patients in the diphenhydramine-lidocaine-antacid mouthwash group. Conclusions and Relevance: Among patients undergoing head and neck radiotherapy, the use of doxepin mouthwash or diphenhydramine-lidocaine-antacid mouthwash vs placebo significantly reduced oral mucositis pain during the first 4 hours after administration; however, the effect size was less than the minimal clinically important difference. Further research is needed to assess longer-term efficacy and safety for both mouthwashes. Trial Registration: ClinicalTrials.gov Identifier: NCT02229539.


Assuntos
Antiácidos/uso terapêutico , Difenidramina/uso terapêutico , Doxepina/uso terapêutico , Neoplasias de Cabeça e Pescoço/radioterapia , Lidocaína/uso terapêutico , Antissépticos Bucais , Lesões por Radiação/tratamento farmacológico , Estomatite/tratamento farmacológico , Administração Tópica , Adulto , Idoso , Idoso de 80 Anos ou mais , Difenidramina/efeitos adversos , Método Duplo-Cego , Doxepina/efeitos adversos , Fadiga/induzido quimicamente , Feminino , Humanos , Lidocaína/efeitos adversos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Dor/tratamento farmacológico , Estomatite/etiologia
4.
Yakugaku Zasshi ; 138(6): 809-813, 2018.
Artigo em Japonês | MEDLINE | ID: mdl-29863052

RESUMO

 During the preclinical research period of drug development, animal testing is widely used to help screen out a drug's dangerous side effects. However, it remains difficult to predict side effects within the central nervous system. Here, we introduce a machine learning-based in vitro system designed to detect seizure-inducing side effects before clinical trial. We recorded local field potentials from the CA1 alveus in acute mouse neocortico-hippocampal slices that were bath-perfused with each of 14 different drugs, and at 5 different concentrations of each drug. For each of these experimental conditions, we collected seizure-like neuronal activity and merged their waveforms as one graphic image, which was further converted into a feature vector using Caffe, an open framework for deep learning. In the space of the first two principal components, the support vector machine completely separated the vectors (i.e., doses of individual drugs) that induced seizure-like events, and identified diphenhydramine, enoxacin, strychnine and theophylline as "seizure-inducing" drugs, which have indeed been reported to induce seizures in clinical situations. Thus, this artificial intelligence-based classification may provide a new platform to pre-clinically detect seizure-inducing side effects of drugs.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Aprendizado de Máquina , Convulsões/induzido quimicamente , Animais , Difenidramina/efeitos adversos , Descoberta de Drogas , Avaliação Pré-Clínica de Medicamentos , Enoxacino/efeitos adversos , Previsões , Humanos , Camundongos , Estricnina/efeitos adversos , Teofilina/efeitos adversos
5.
Cochrane Database Syst Rev ; 4: CD007094, 2018 04 10.
Artigo em Inglês | MEDLINE | ID: mdl-29633783

RESUMO

BACKGROUND: Cough causes concern for parents and is a major cause of outpatient visits. Cough can impact quality of life, cause anxiety, and affect sleep in children and their parents. Honey has been used to alleviate cough symptoms. This is an update of reviews previously published in 2014, 2012, and 2010. OBJECTIVES: To evaluate the effectiveness of honey for acute cough in children in ambulatory settings. SEARCH METHODS: We searched CENTRAL (2018, Issue 2), which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (2014 to 8 February 2018), Embase (2014 to 8 February 2018), CINAHL (2014 to 8 February 2018), EBSCO (2014 to 8 February 2018), Web of Science (2014 to 8 February 2018), and LILACS (2014 to 8 February 2018). We also searched ClinicalTrials.gov and the World Health Organization International Clinical Trial Registry Platform (WHO ICTRP) on 12 February 2018. The 2014 review included searches of AMED and CAB Abstracts, but these were not searched for this update due to lack of institutional access. SELECTION CRITERIA: Randomised controlled trials comparing honey alone, or in combination with antibiotics, versus no treatment, placebo, honey-based cough syrup, or other over-the-counter cough medications for children aged 12 months to 18 years for acute cough in ambulatory settings. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: We included six randomised controlled trials involving 899 children; we added three studies (331 children) in this update.We assessed two studies as at high risk of performance and detection bias; three studies as at unclear risk of attrition bias; and three studies as at unclear risk of other bias.Studies compared honey with dextromethorphan, diphenhydramine, salbutamol, bromelin (an enzyme from the Bromeliaceae (pineapple) family), no treatment, and placebo. Five studies used 7-point Likert scales to measure symptomatic relief of cough; one used an unclear 5-point scale. In all studies, low score indicated better cough symptom relief.Using a 7-point Likert scale, honey probably reduces cough frequency better than no treatment or placebo (no treatment: mean difference (MD) -1.05, 95% confidence interval (CI) -1.48 to -0.62; I² = 0%; 2 studies; 154 children; moderate-certainty evidence; placebo: MD -1.62, 95% CI -3.02 to -0.22; I² = 0%; 2 studies; 402 children; moderate-certainty evidence). Honey may have a similar effect as dextromethorphan in reducing cough frequency (MD -0.07, 95% CI -1.07 to 0.94; I² = 87%; 2 studies; 149 children; low-certainty evidence). Honey may be better than diphenhydramine in reducing cough frequency (MD -0.57, 95% CI -0.90 to -0.24; 1 study; 80 children; low-certainty evidence).Giving honey for up to three days is probably more effective in relieving cough symptoms compared with placebo or salbutamol. Beyond three days honey probably had no advantage over salbutamol or placebo in reducing cough severity, bothersome cough, and impact of cough on sleep for parents and children (moderate-certainty evidence). With a 5-point cough scale, there was probably little or no difference between the effects of honey and bromelin mixed with honey in reducing cough frequency and severity.Adverse events included nervousness, insomnia, and hyperactivity, experienced by seven children (9.3%) treated with honey and two children (2.7%) treated with dextromethorphan (risk ratio (RR) 2.94, 95% Cl 0.74 to 11.71; I² = 0%; 2 studies; 149 children; low-certainty evidence). Three children (7.5%) in the diphenhydramine group experienced somnolence (RR 0.14, 95% Cl 0.01 to 2.68; 1 study; 80 children; low-certainty evidence). When honey was compared with placebo, 34 children (12%) in the honey group and 13 (11%) in the placebo group complained of gastrointestinal symptoms (RR 1.91, 95% CI 1.12 to 3.24; I² = 0%; 2 studies; 402 children; moderate-certainty evidence). Four children who received salbutamol had rashes compared to one child in the honey group (RR 0.19, 95% CI 0.02 to 1.63; 1 study; 100 children; moderate-certainty evidence). No adverse events were reported in the no-treatment group. AUTHORS' CONCLUSIONS: Honey probably relieves cough symptoms to a greater extent than no treatment, diphenhydramine, and placebo, but may make little or no difference compared to dextromethorphan. Honey probably reduces cough duration better than placebo and salbutamol. There was no strong evidence for or against using honey. Most of the children received treatment for one night, which is a limitation to the results of this review. There was no difference in occurrence of adverse events between the honey and control arms.


Assuntos
Antitussígenos/uso terapêutico , Apiterapia/métodos , Tosse/terapia , Dextrometorfano/uso terapêutico , Difenidramina/uso terapêutico , Adolescente , Albuterol/uso terapêutico , Antitussígenos/efeitos adversos , Apiterapia/efeitos adversos , Bromelaínas/uso terapêutico , Broncodilatadores/uso terapêutico , Criança , Pré-Escolar , Dextrometorfano/efeitos adversos , Difenidramina/efeitos adversos , Mel/efeitos adversos , Humanos , Lactente , Placebos/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto
6.
Gastrointest Endosc ; 88(4): 695-702, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29689257

RESUMO

BACKGROUND AND AIMS: Chronic opioid use increases tolerance to sedatives. Diphenhydramine is recommended for difficult-to-sedate patients during endoscopic procedures. We hypothesized that the addition of diphenhydramine to midazolam and fentanyl would improve objective and subjective measures of procedural sedation. METHODS: This randomized, double-blind, placebo-controlled trial included patients on chronic opioids undergoing colonoscopy. Patients were randomized to receive 50 mg of diphenhydramine intravenously (n = 61) or placebo (n = 58), in addition to fentanyl and midazolam. Baseline characteristics, amount of fentanyl and midazolam, procedure times, and adverse events were recorded. Quality of sedation was assessed by the physician and nurse. Patients rated pain and amnesia on a 10-point scale. RESULTS: There was no difference in amounts of fentanyl (125.4 ± 56.2 µg vs 126.9 ± 53.5 µg, P = .88) and midazolam (4.9 ± 2.1 mg vs 5 ± 1.9 mg, P = .79) used. The mean sedation scores from the physician (6.2 ± 1.1 vs 5.3 ± 1.2, P =.0002) and nurses (5.6 ± 1.5 vs 5.1 ± 1.4, P =.04) were statistically significant in favor of the diphenhydramine arm. Patient scores for pain (2.05 ± 2.17 vs 3.09 ± 3.95, P =.047) and amnesia (7.8 ± 3.4 vs 6.5 ± 3.8, P =.047) favored the group that received diphenhydramine. Qualitative assessment showed no significant difference between the groups. There was no difference in induction time (P = .86), procedure duration (P = .98), or recovery time (P = .16). Hypotensive episodes were more common in the placebo group (P = .027). CONCLUSIONS: In patients on chronic opioid therapy, administration of diphenhydramine does not allow for lower doses of procedural sedatives but improves quality of sedation without increasing the number of adverse events. (Clinical trial registration number: NCT T01967433.).


Assuntos
Colonoscopia , Sedação Profunda/métodos , Difenidramina , Hipnóticos e Sedativos , Idoso , Analgésicos Opioides/efeitos adversos , Anestésicos Intravenosos , Colonoscopia/efeitos adversos , Difenidramina/efeitos adversos , Feminino , Fentanila , Humanos , Hipnóticos e Sedativos/efeitos adversos , Masculino , Midazolam , Pessoa de Meia-Idade , Dor Processual/etiologia , Fatores de Tempo
7.
Emerg Med J ; 35(5): 325-331, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29431143

RESUMO

OBJECTIVES: To determine the effectiveness of prophylactic anticholinergic medications in reducing extrapyramidal symptoms in patients taking acute antiemetics with a dopamine D2 receptor antagonist effect. METHODS: Systematic searches of all published studies through March 2017 were identified from PubMed, Cochrane library, Embase, Web of Science and Scopus. Only randomised controlled trials of patients receiving dopamine D2 antagonist antiemetic therapy for acute migraine in which an anticholinergic or placebo was compared were included. Pooled ORs were calculated for incidence of extrapyramidal symptoms and sedation. RESULTS: Four placebo-controlled randomised controlled trials consisting of 737 patients met the inclusion criteria for our meta-analysis. The effect of diphenhydramine differed depending on the method of administration of the antiemetic. When the antiemetic was delivered as a 2 min antiemetic bolus, the odds of extrapyramidal symptoms were significantly reduced in the diphenhydramine group compared with placebo (OR 0.42; 95% CI 0.22 to 0.81; P=0.01). However, when the antiemetic was given as a 15 min infusion, there was no significant difference in extrapyramidal symptoms with or without diphenhydramine (OR 1.06; 95% CI 0.58 to 1.91; P=0.85). The lowest incidence of extrapyramidal symptoms was observed in patients receiving a 15 min antiemetic infusion without diphenhydramine prophylaxis (9.8%). In two trials including 351 patients that dichotomously reported sedation scales, diphenhydramine had significantly higher rates of sedation (31.6%vs19.2%, OR 2.01, 95% CI 1.21 to 3.33; P=0.007). CONCLUSION: Prophylactic diphenhydramine reduces extrapyramidal symptoms in patients receiving bolus antiemetic therapy with a dopamine D2 antagonist effect, but not when it is given as an infusion. Because of significantly greater sedation with diphenhydramine, the most effective strategy is to administer the D2 antagonist antiemetic as a 15 min infusion without prophylaxis.


Assuntos
Antieméticos/efeitos adversos , Doenças dos Gânglios da Base/tratamento farmacológico , Doenças dos Gânglios da Base/prevenção & controle , Antagonistas Colinérgicos/farmacologia , Antieméticos/uso terapêutico , Antagonistas Colinérgicos/uso terapêutico , Difenidramina/efeitos adversos , Difenidramina/uso terapêutico , Humanos
8.
J Am Vet Med Assoc ; 251(7): 804-813, 2017 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-28967819

RESUMO

OBJECTIVE To evaluate the effects of IV diphenhydramine hydrochloride administration on cardiorespiratory variables in anesthetized dogs undergoing mast cell tumor (MCT) excision. DESIGN Randomized, blinded clinical trial. ANIMALS 16 client-owned dogs with MCTs. PROCEDURES In a standardized isoflurane anesthesia session that included mechanical ventilation, dogs received diphenhydramine hydrochloride (1 mg/kg [0.45 mg/lb], IV; n = 8) or an equivalent volume of saline (0.9% NaCl) solution (IV; control treatment; 8) 10 minutes after induction. Cardiorespiratory variables were recorded throughout anesthesia and MCT excision, and blood samples for determination of plasma diphenhydramine and histamine concentrations were collected prior to premedication (baseline), throughout anesthesia, and 2 hours after extubation. RESULTS Cardiorespiratory values in both treatment groups were acceptable for anesthetized dogs. Mean ± SD diastolic arterial blood pressure was significantly lower in the diphenhydramine versus control group during tumor dissection (52 ± 10 mm Hg vs 62 ± 9 mm Hg) and surgical closure (51 ± 10 mm Hg vs 65 ± 9 mm Hg). Mean arterial blood pressure was significantly lower in the diphenhydramine versus control group during surgical closure (65 ± 12 mm Hg vs 78 ± 11 mm Hg), despite a higher cardiac index value. Plasma histamine concentrations were nonsignificantly higher than baseline during maximal manipulation of the tumor and surgical preparation in the diphenhydramine group and during surgical dissection in the control group. CONCLUSIONS AND CLINICAL RELEVANCE IV administration of diphenhydramine prior to MCT excision had no clear clinical cardiorespiratory benefits over placebo in isoflurane-anesthetized dogs.


Assuntos
Difenidramina/farmacologia , Doenças do Cão/cirurgia , Sarcoma de Mastócitos/veterinária , Anestésicos Inalatórios , Animais , Pressão Sanguínea/efeitos dos fármacos , Difenidramina/efeitos adversos , Cães , Feminino , Frequência Cardíaca/efeitos dos fármacos , Isoflurano , Masculino , Sarcoma de Mastócitos/cirurgia
9.
Neurology ; 89(20): 2075-2082, 2017 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-29046364

RESUMO

OBJECTIVE: To determine outcomes among patients with migraine in the emergency department (ED) who receive IV hydromorphone vs IV prochlorperazine + diphenhydramine. METHODS: This study was conducted in 2 EDs in New York City. Patients who met international criteria for migraine were eligible for participation if they had not used an opioid within the previous month. Clinicians, participants, investigators, and research personnel were blinded to treatment. Patients were randomized in blocks of 4. Participants received hydromorphone 1 mg or prochlorperazine 10 mg + diphenhydramine 25 mg. Diphenhydramine was administered to prevent akathisia, a common side effect of IV prochlorperazine. The primary outcome was sustained headache relief, defined as achieving a headache level of mild or none within 2 hours of medication administration and maintaining that level for 48 hours without the requirement of rescue medication. A planned interim analysis was conducted once 48-hour data were available for 120 patients. RESULTS: The trial was halted by the data monitoring committee after 127 patients had been enrolled. The primary outcome was achieved in the prochlorperazine arm by 37 of 62 (60%) participants and in the hydromorphone arm by 20 of 64 (31%) participants (difference 28%, 95% confidence interval 12-45, number needed to treat 4, 95% confidence interval 2-9). CONCLUSIONS: IV hydromorphone is substantially less effective than IV prochlorperazine for the treatment of acute migraine in the ED and should not be used as first-line therapy. CLINICALTRIALSGOV IDENTIFIER: NCT02389829. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that for patients in the ED with migraine, IV prochlorperazine + diphenhydramine is superior to IV hydromorphone.


Assuntos
Analgésicos Opioides/farmacologia , Difenidramina/farmacologia , Antagonistas de Dopamina/farmacologia , Hidromorfona/farmacologia , Hipnóticos e Sedativos/farmacologia , Transtornos de Enxaqueca/tratamento farmacológico , Proclorperazina/farmacologia , Doença Aguda , Administração Intravenosa , Adulto , Analgésicos Opioides/administração & dosagem , Difenidramina/administração & dosagem , Difenidramina/efeitos adversos , Antagonistas de Dopamina/administração & dosagem , Método Duplo-Cego , Quimioterapia Combinada , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Humanos , Hidromorfona/administração & dosagem , Hidromorfona/efeitos adversos , Hipnóticos e Sedativos/administração & dosagem , Masculino , Pessoa de Meia-Idade , Proclorperazina/administração & dosagem , Proclorperazina/efeitos adversos
10.
J Dev Behav Pediatr ; 38(9): 765-771, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28937452

RESUMO

OBJECTIVE: Sleep disorders are common in individuals with Williams syndrome (WS), and sleep disturbance has a significant negative effect on attention, learning, and behavior. The use of sleep-inducing medicine in individuals with WS has not been widely investigated. The objective of this study was to evaluate the use and effectiveness of sleep medications among a large sample of individuals with WS by parent survey. METHODS: A survey of the use and effectiveness of sleep medications was completed by 513 (of 2846) members of the Williams Syndrome Association. The online survey asked for the age at initiation, degree of effectiveness (helpful, somewhat helpful, and not helpful), and side effects. RESULTS: One hundred thirty participants (25%) indicated that their family member with WS had taken medication to help with sleep. Melatonin was the most commonly reported medication taken for sleep, with 91% of parents reporting that it was "helpful" or "somewhat helpful" for their child with WS. Those who reported taking melatonin reported very few, if any, side effects. CONCLUSION: This parent-completed survey is a preliminary study showing the positive benefit of melatonin for individuals with WS who have disrupted sleep. The findings support the need for further study of the use of melatonin, in addition to behavioral sleep aids, given evidence that sleep disturbance negatively influences cognition and behavior.


Assuntos
Depressores do Sistema Nervoso Central/farmacologia , Difenidramina/farmacologia , Hipnóticos e Sedativos/farmacologia , Melatonina/farmacologia , Transtornos do Sono-Vigília/tratamento farmacológico , Síndrome de Williams/complicações , Adolescente , Adulto , Depressores do Sistema Nervoso Central/efeitos adversos , Criança , Pré-Escolar , Difenidramina/efeitos adversos , Feminino , Humanos , Hipnóticos e Sedativos/efeitos adversos , Lactente , Masculino , Melatonina/efeitos adversos , Pais , Transtornos do Sono-Vigília/etiologia , Adulto Jovem
11.
Obstet Gynecol ; 130(2): 374-376, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28697105

RESUMO

BACKGROUND: Fetal tachycardia is attributable to a variety of etiologies, including an untreated maternal medical condition or an indicator of potential fetal compromise. Maternal medication administration may also affect the fetal heart rate. CASE: A 28-year-old nulliparous patient at 41 weeks of gestation was treated for pruritus with intravenous diphenhydramine after epidural administration of fentanyl. Within 14 minutes, the fetal heart rate increased from a baseline of 155 beats per minute (bpm) to more than 200 bpm while maintaining moderate variability. This was accompanied by an increase in uterine contractions occurring every 1.5 minutes. The fetal tachycardia lasted 51 minutes; several hours later, a healthy neonate was delivered. CONCLUSION: Diphenhydramine may produce transient fetal tachycardia as well as increased maternal uterine activity.


Assuntos
Difenidramina/efeitos adversos , Doenças Fetais/induzido quimicamente , Frequência Cardíaca Fetal/efeitos dos fármacos , Antagonistas dos Receptores Histamínicos H1/efeitos adversos , Taquicardia/induzido quimicamente , Taquicardia/embriologia , Administração Intravenosa , Adulto , Analgésicos Opioides , Cesárea , Feminino , Fentanila/efeitos adversos , Idade Gestacional , Humanos , Recém-Nascido , Trabalho de Parto Induzido , Gravidez , Prurido/induzido quimicamente , Prurido/tratamento farmacológico , Contração Uterina/efeitos dos fármacos
12.
Pharmacoepidemiol Drug Saf ; 26(10): 1164-1171, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28653802

RESUMO

PURPOSE: H1-antihistamines are commonly used in infants and children for the relief of histamine-mediated symptoms in a variety of conditions. Little is known about their safety profile in these patients. We performed a comparative analysis of the safety profiles of H1-antihistamines using data from the WHO database (VigiBase). METHODS: We selected adverse drug reaction (ADR) reports on H1-antihistamines in children (0-16 years) up to June 2014 from VigiBase. ADRs were codified according to MedDRA terminology. The reporting odds ratios (RORs) with 95% confidence for drug-reaction pairs were calculated. RESULTS: The analysis was performed on 8918 reports related to antihistamines, corresponding to 19503 drug reaction pairs for 68 different drugs. Most of reports involved children aged 2 to 6 years (32%) and 6 to 12 years (34%). Most reported drugs were cetirizine (1608 reports, corresponding to 18%), loratadine (16%), and diphenhydramine (10%). ADRs were classified as serious in 23% of cases, and 400 cases had a fatal outcome. We found a significant associations for several drug-reaction pairs such as levocetirizine and epilepsy (ROR, 6.57; 95% confidence interval [CI], 1.51-28.53) and chlorphenamine and toxic epidermal necrolysis (ROR, 7.29; 95% CI, 2.39-22.2). CONCLUSIONS: H1-antihistamines are among the most used drugs in pediatrics, also in an off-label manner. Our data highlights associations with serious and unexpected ADRs. Educative intervention to clinicians and parents are needed to help doctors to make proper choices on the drug treatment and for the early detection of ADRs to maximize the benefits and reduce the risk of ADRs in these patients.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos/estatística & dados numéricos , Epilepsia/epidemiologia , Antagonistas dos Receptores Histamínicos H1/efeitos adversos , Síndrome de Stevens-Johnson/epidemiologia , Adolescente , Cetirizina/efeitos adversos , Criança , Mortalidade da Criança , Pré-Escolar , Clorfeniramina/efeitos adversos , Bases de Dados Factuais/estatística & dados numéricos , Difenidramina/efeitos adversos , Epilepsia/induzido quimicamente , Feminino , Humanos , Lactente , Recém-Nascido , Loratadina/efeitos adversos , Masculino , Farmacovigilância , Síndrome de Stevens-Johnson/etiologia , Organização Mundial da Saúde
13.
Int J Clin Pharm ; 39(4): 808-817, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28466395

RESUMO

Background The unintentional misuse of over-the-counter sleep aids among older adults is an important public health problem and a focus of Healthy People 2020. Accordingly, the 2015 Beers Criteria for Potentially Inappropriate Medication Use in Older Adults recommends that individuals 65 years or older avoid use of diphenhydramine and doxylamine; however, many over-the-counter sleep products contain these active ingredients. Objective To identify the proportion of older adults using an over-the-counter medication containing diphenhydramine or doxylamine, and compare their characteristics with older adults using an over-the-counter medication that does not contain these ingredients. Setting Study participants were recruited from the Community Registry of the Pittsburgh Claude D. Pepper Older Americans Independence Center. Method The study sample was taken from a larger survey of 1025 participants on sleep health and over-the-counter sleep medication use conducted from February to April 2015. A subset of 169 participants aged 65 and older reporting taking at least one over-the-counter product to improve sleep within the past 30 days (16.5%) were selected for our analysis on associations between participant characteristics and potentially inappropriate use of over-the-counter sleep medications. Main outcome measure The proportion and characteristics of older adults taking at least one over-the-counter medication containing diphenhydramine or doxylamine. Results Of the 223 over-the-counter sleep medications listed by participants, 115 (52%) contained diphenhydramine or doxylamine. Using the Beers Criteria, we found that more than half of participants (59%) had used a potentially inappropriate over-the-counter medication containing diphenhydramine or doxylamine to improve sleep within the past 30 days. Participants taking at least one diphenhydramine or doxylamine containing medication were less likely to be aware of any safety risks in taking over-the-counter sleep medications than participants not taking these products (38 vs 49%, p = 0.016). Conclusion A majority of older adults in a limited sample from the United States taking an over-the-counter medication to improve sleep are taking a product containing diphenhydramine or doxylamine, both of which are classified as potentially inappropriate for older adults. Awareness of the safety risks of over-the-counter medications and addressing conditions that impact sleep quality could be facilitated through consultation with pharmacists and other healthcare providers.


Assuntos
Difenidramina/uso terapêutico , Doxilamina/uso terapêutico , Antagonistas dos Receptores Histamínicos H1/uso terapêutico , Medicamentos sem Prescrição/uso terapêutico , Medicamentos Indutores do Sono/uso terapêutico , Transtornos do Sono-Vigília/tratamento farmacológico , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Difenidramina/efeitos adversos , Doxilamina/efeitos adversos , Feminino , Antagonistas dos Receptores Histamínicos H1/efeitos adversos , Humanos , Masculino , Medicamentos sem Prescrição/efeitos adversos , Medicamentos Indutores do Sono/efeitos adversos , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/psicologia , Inquéritos e Questionários
14.
J Clin Pharm Ther ; 42(3): 370-371, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28251653

RESUMO

WHAT IS KNOWN AND OBJECTIVE: A prescribing cascade if often treated by discontinuing both medications. We describe an intervention to mitigate a prescribing cascade while continuing a clinically necessary medication without negatively impacting the patient. CASE SUMMARY: A 77-year-old women experienced probable acetylcholinesterase inhibitor-induced rhinorrhea and subsequently self-medicated with diphenhydramine which lead to worsening cognitive function. We reduced the dose of the acetylcholinesterase inhibitor and discontinued the diphenhydramine. The symptoms of rhinorrhea were subsequently reduced without negatively impacting cognition. WHAT IS NEW AND CONCLUSION: This was the first published prescribing cascade intervention that did not require discontinuation of both medications, which may be emulated in future prescribing cascade cases.


Assuntos
Inibidores da Colinesterase/efeitos adversos , Difenidramina/efeitos adversos , Rinite/diagnóstico , Idoso , Inibidores da Colinesterase/administração & dosagem , Cognição/efeitos dos fármacos , Difenidramina/administração & dosagem , Relação Dose-Resposta a Droga , Feminino , Humanos , Rinite/induzido quimicamente , Automedicação
15.
J Pharmacol Sci ; 133(2): 70-78, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28215473

RESUMO

Various biological factors have been implicated in convulsive seizures, involving side effects of drugs. For the preclinical safety assessment of drug development, it is difficult to predict seizure-inducing side effects. Here, we introduced a machine learning-based in vitro system designed to detect seizure-inducing side effects. We recorded local field potentials from the CA1 alveus in acute mouse neocortico-hippocampal slices, while 14 drugs were bath-perfused at 5 different concentrations each. For each experimental condition, we collected seizure-like neuronal activity and merged their waveforms as one graphic image, which was further converted into a feature vector using Caffe, an open framework for deep learning. In the space of the first two principal components, the support vector machine completely separated the vectors (i.e., doses of individual drugs) that induced seizure-like events and identified diphenhydramine, enoxacin, strychnine and theophylline as "seizure-inducing" drugs, which indeed were reported to induce seizures in clinical situations. Thus, this artificial intelligence-based classification may provide a new platform to detect the seizure-inducing side effects of preclinical drugs.


Assuntos
Convulsões/induzido quimicamente , Máquina de Vetores de Suporte , Animais , Região CA1 Hipocampal/efeitos dos fármacos , Difenidramina/efeitos adversos , Enoxacino/efeitos adversos , Técnicas In Vitro , Masculino , Camundongos , Camundongos Endogâmicos ICR , Estricnina/efeitos adversos , Teofilina/efeitos adversos
18.
Am J Hosp Palliat Care ; 34(10): 954-957, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27625354

RESUMO

BACKGROUND: Diphenhydramine (DPH) is most commonly used via oral, topical, intramuscular (IM) and intravenous (IV) routes for the palliation of pruritus, treatment of extrapyramidal symptoms, management of parkinsonism and for allergic reactions. However, many hospice patients are unable to take oral medications and/or do not have IV access. Moreover, topical administration has a relatively slow rate of absorption. For this reason, in the hospice setting it is not uncommon for diphenhydramine to be administered via the subcutaneous (SC) route secondary to its ease of access, low infection rates and its low levels of discomfort. In contrast, outside the hospice setting, subcutaneous DPH has not been widely used, primarily because of a handful of case reports published in the 1990's that report skin necrosis following subcutaneous administration of DPH for local anesthesia. Since these early case reports, however, there has been very little in the way of research to examine this further. The aim of this study is to provide objective data concerning the safe use of subcutaneous diphenhydramine, as part of our efforts to improve upon safe practices in our organization. METHODS: This is a retrospective review of records from 6 of our inpatient hospice units obtained from our pharmacy database for patients who received at least one subcutaneous injection of diphenhydramine between 2012-2015. Selected patients were then subsequently screened for post-administration skin necrosis, as recorded in our quality assurance database during the same time period. RESULTS: A total of 648 diphenhydramine subcutaneous injections were administered in109 individual patients. None of the patients were reported to have an adverse cutaneous reaction. CONCLUSIONS: This retrospective review demonstrates that subcutaneous diphenhydramine injection is a safe alternative to oral and other parenteral routes, and may be particularly valuable in terminally ill patients, who are often unable to swallow and are without IV access.


Assuntos
Difenidramina/administração & dosagem , Difenidramina/efeitos adversos , Hospitais para Doentes Terminais/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças dos Gânglios da Base/tratamento farmacológico , Difenidramina/uso terapêutico , Feminino , Humanos , Injeções Subcutâneas , Masculino , Pessoa de Meia-Idade , Necrose/induzido quimicamente , Prurido/tratamento farmacológico , Estudos Retrospectivos , Pele/patologia
19.
Vestn Oftalmol ; 132(5): 81-85, 2016.
Artigo em Russo | MEDLINE | ID: mdl-27911431

RESUMO

Treatment of allergic diseases of eyelids and conjunctiva (conjunctivites and blepharoconjunctivites) often presents difficulties due to peculiarities of their pathogenesis - allergic and vascular reactions, disorder of lacrimal production, meibomian gland dysfunction, and possible bacterial contamination. It has been suggested to use Ocumethyl, which contains zinc sulfate (binding, drying, anti-inflammatory, and antiseptic effect), diphenhydamine hydrochloride (an Н1-antihistamine that decreases capillary permeability and helps resolve conjunctival and eyelid edema), naphazoline hydrochloride (a sympathomimetic notable for its strong, rapid, and long-lasting vasoconstrictive effect), and methylene blue (antiseptic effect, disintoxication, and antioxidant activity). A total of 80 patients with chronic allergic conjunctivitis, blepharoconjuntivitis, or giant papillary conjunctivitis associated with contact lens wearing were treated with Ocumethyl instillations (3 times daily for 15-30 days). A clinically significant effect was obtained in 77-91% of patients depending on the disease entity.


Assuntos
Conjuntivite Alérgica , Difenidramina/administração & dosagem , Doenças Palpebrais , Hipersensibilidade/complicações , Azul de Metileno/administração & dosagem , Nafazolina/administração & dosagem , Sulfato de Zinco/administração & dosagem , Antialérgicos/administração & dosagem , Antialérgicos/efeitos adversos , Conjuntivite Alérgica/diagnóstico , Conjuntivite Alérgica/tratamento farmacológico , Conjuntivite Alérgica/fisiopatologia , Difenidramina/efeitos adversos , Combinação de Medicamentos , Doenças Palpebrais/diagnóstico , Doenças Palpebrais/tratamento farmacológico , Doenças Palpebrais/etiologia , Doenças Palpebrais/fisiopatologia , Feminino , Humanos , Instilação de Medicamentos , Masculino , Azul de Metileno/efeitos adversos , Pessoa de Meia-Idade , Nafazolina/efeitos adversos , Soluções Oftálmicas , Resultado do Tratamento , Sulfato de Zinco/efeitos adversos
20.
Pak J Pharm Sci ; 29(3 Suppl): 1027-32, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27383495

RESUMO

To evaluate the safety and efficacy of Linkus, Aminophylline with Diphenhydramine group and Acefyllin Piperazine with Diphenhydramine cough syrup on children having cough and sleep difficulty associated with cough. To determine the effects of Linkus polyherbal syrup (group A) and compared with other parallel allopathic groups (Group B and C) for cough on children and associated sleep quality and improvement. 360 children having cough inducted in 3 different groups randomly selected. Three parallel groups were the part of the study. The first study group was the herbal syrup Linkus, second group of children were taking a syrup of multinational pharmaceutical industry having Aminophylline plus Diphenhydramine however the third group received another famous brand having Acefyllin Piperazine with Diphenhydramine. Informed assent and informed consent have taken from the study subjects and their parents. Subjects with acute cough were included in the study however the subjects with chronic cough considered to be excluded. Every group of individual in the study was informed about the investigational drugs provided. Ethnic groups, frequency of cough and diseases illness (<0.05) were determine on every group on the investigational syrup. Cough impact on child and its sleep of three different syrups (every group) were assessed on day1 and day 14(p<0.001) via a likert scale. For the evaluation of pain assessment Wong baker face scale were used and level of significance in each group (p<0.001). Significant results were observed in the Linkus Group as compared to the other parallel groups including Aminophylline plus Diphenhydramine and Acefyllin Piperazine with Diphenhydramine on day 14 (p<0.001). Side effects on group B and group C (Aminophylline with Diphenhydramine and Acefyllin Piperazine with Diphenhydramine) were almost similar in number however Linkus syrup has minimum side effects on study duration. Polyherbal syrup Linkus shows better results in treatment of cough including side effects as compare to the other parallel groups B and C (Aminophylline with Diphenhydramine and Acefyllin Piperazine with Diphenhydramine). For nocturnal sleep Linkus providing better results in cough and associated problems. Pain were significantly reduce on day 14 with the herbal Linkus syrup group A (<0.001). Group B and C found less effective with more side effects as compared to Linkus syrup. Poly herbal Linkus syrup could substantially improve the clinical effect and relieves coughs and benefit lung functions and better sleep facilitation.


Assuntos
Aminofilina/uso terapêutico , Antitussígenos/uso terapêutico , Broncodilatadores/uso terapêutico , Tosse/tratamento farmacológico , Difenidramina/uso terapêutico , Hipnóticos e Sedativos/uso terapêutico , Faringite/tratamento farmacológico , Transtornos do Sono-Vigília/tratamento farmacológico , Sono/efeitos dos fármacos , Teofilina/análogos & derivados , Fatores Etários , Aminofilina/efeitos adversos , Antitussígenos/efeitos adversos , Broncodilatadores/efeitos adversos , Criança , Pré-Escolar , Tosse/complicações , Tosse/fisiopatologia , Difenidramina/efeitos adversos , Quimioterapia Combinada , Feminino , Humanos , Hipnóticos e Sedativos/efeitos adversos , Masculino , Paquistão , Faringite/etiologia , Faringite/fisiopatologia , Transtornos do Sono-Vigília/etiologia , Transtornos do Sono-Vigília/fisiopatologia , Teofilina/efeitos adversos , Teofilina/uso terapêutico , Fatores de Tempo , Resultado do Tratamento
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