I need help with pharm.

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I have looked everywhere for the answer to this question. Why are antihistamines often used in place of sedative-hypnotics for elderly patients? I really cant find this please help

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Specializes in Palliative Care, NICU/NNP.

Benadryl is often used at bedtime for its sedative qualities. That's the most common one I can think of. Maybe because it is OTC, and is less addictive than other drugs used for sleep. Or, maybe some of the newer sleepers aren't in the facilitie's formulary. Just guesses.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

hi, npicha!

i wasn't aware that antihistamines were approved as sedatives for the elderly. the only ones i know of that are prescribed as sedatives or hypnotics and approved for this use are bendryl (diphenhydramine) and promethazine (phenergan). phenergan is most often used pre-operatively and not usually as a hypnotic. benadryl has very few side effects or drug interactions which is probably why it is considered safe to use for sleep in the elderly. can't find any specific written source on that for you though.

welcome to allnurses! :welcome:

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

The older, first-generation antihistamines have the tendency to induce drowsiness and sleepiness. The newer generation antihistamines such as Zyrtec, Allegra, Claritin, and Clarinex are supposed to be non-drowsy and non-sedating. On the other hand, the first generation antihistamines such as Benadryl (diphenhydramine HCL), Tavist, Unisom (doxylamine succinate), and chlorpheniramine maleate tend to be very sedating.

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Specializes in Palliative Care, NICU/NNP.

"I wasn't aware that antihistamines were approved as sedatives for the elderly. The only ones I know of that are prescribed as sedatives or hypnotics and approved for this use are Bendryl (diphenhydramine) and promethazine (Phenergan)."

Daytonite,

Isn't that what I just said about Benadryl? I didn't call it a sedative but that it's used for its sedative properties. :smilecoffeecup:

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

the use of diphenydramine (benadryl) for sleep aid in the elderly should actually be discouraged. refer to this link: http://www.ashp.org/s_ashp/sec_news_article.asp?cid=167&did=2024&id=2613

benadryl has a very long half-life that can last up to 8 hours. this drug has strong anticholinergic effects which can lead to confusion, blurred vision, constipation, dry mouth, light-headedness, difficulty starting and continuing to urinate, and loss of bladder control - issues that the elderly are already faced with due to the aging process. elderly patients tend to still suffer from the effects of this drug even after its established half-life.

the newer classificationns of hypnotics such as zolpidem (ambien), zaleplon (sonata) and eszopiclone (lunesta) have shorter half-lives and have been shown to cause less adverse effects when used because they are non-benzodiazepines. however, all hypnotics should be used for short-term treatment not lasting longer than 2 weeks.

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Specializes in Palliative Care, NICU/NNP.
the use of diphenydramine (benadryl) for sleep aid in the elderly should actually be discouraged. refer to this link: http://www.ashp.org/s_ashp/sec_news_article.asp?cid=167&did=2024&id=2613

benadryl has a very long half-life that can last up to 8 hours. this drug has strong anticholinergic effects which can lead to confusion, blurred vision, constipation, dry mouth, light-headedness, difficulty starting and continuing to urinate, and loss of bladder control - issues that the elderly are already faced with due to the aging process. elderly patients tend to still suffer from the effects of this drug even after its established half-life.

the newer classificationns of hypnotics such as zolpidem (ambien), zaleplon (sonata) and eszopiclone (lunesta) have shorter half-lives and have been shown to cause less adverse effects when used because they are non-benzodiazepines. however, all hypnotics should be used for short-term treatment not lasting longer than 2 weeks.

i agree with your thoughts on the elderly but people at home do use benadryl or tylenol with benadryl for sleep. in a facility a dose of 12.5 mg could be used. these new drugs are very expensive and may not be in the facilitie's formulary. i work in a large hospital and ambiem is the only sleeper in the formulary.

to be honest i don't see benadryl ordered for sleep but her question revolved around the use of antihistamines. there are alot of factors that go into drug choices.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

I was just clarifying since the OP specifically asked about "elderly patients". The use of antihistamines, specifically Diphenydramine in the elderly is a totally outdated and unsafe medical practice, period.

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Specializes in Palliative Care, NICU/NNP.
I was just clarifying since the OP specifically asked about "elderly patients". The use of antihistamines, specifically Diphenydramine in the elderly is a totally outdated and unsafe medical practice, period.

Is that in your humble opinion???

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

No, evidence from research leads me to believe it. In addition to lecture from advanced pharmacology from NP school. I'm not forcing you to stick to it, you can believe otherwise if that's what will make you happy.

http://archinte.ama-assn.org/cgi/content/abstract/161/17/2091

http://www.massgeneral.org/pharmacy/Newsletters/2002/August%202002/benadryl.htm

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Specializes in Palliative Care, NICU/NNP.

pinoyNP,

It's not about making me happy. It's about having read those links and a few others. Neither one of them state emphatically not to use the drug, period. They are saying be careful, know your patient and assess for side effects. I hardly see this drug used, and the side effects they listed could happen to a lot of people of all ages.

"Diphenydramine in the elderly is a totally outdated and unsafe medical practice, period." I just found this statement to be a bit black and white with no gray, period.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
"Diphenydramine in the elderly is a totally outdated and unsafe medical practice, period." I just found this statement to be a bit black and white with no gray, period.
I am not going to opine on the aforesaid statements.

I am simply going to suggest that we back up our statements with links to reputable sources if we really want people on these forums to accept them as factual.

Good night. This is not worth the argument. :)

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