Subscribe to RSS
Download PDF
DOI: 10.1055/s-0032-1332949
Diphenhydramin-Abhängigkeit und -Entzug
Systematische Literaturübersicht und ein FallberichtDiphenhydramine Addiction and DetoxificationA Systematic Review and Case ReportPublication History
Publication Date:
04 March 2013 (online)
Zusammenfassung
Anliegen: Unsere systematische Literaturübersicht soll auf die Gefahr der Diphenhydramin (DPH)-Abhängigkeit hinweisen.
Methodik: Es erfolgte eine Recherche in Pubmed zwischen 1972 und 2012. Zudem berichten wir von einer Patientin mit DPH-Abhängigkeit.
Ergebnisse: Es ergeben sich gesicherte Hinweise für ein Abhängigkeitspotenzial von DPH.
Schlussfolgerung: Insbesondere bei Patienten mit Abhängigkeitserkrankungen in der Vorgeschichte muss an die Möglichkeit einer DPH-Abhängigkeit gedacht und diese bei Verdacht durch eine gezielte Exploration überprüft werden.
Abstract
Objective: In many countries diphenhydramine (DPH) is commonly available over the counter, frequently used, and generally regarded as a harmless drug. It is used as a sedative, antiallergic or antiemetic substance.
Methods: We present a systematic review of literature search in Pubmed from 1972 to 2012 describing DPH addiction. The literature search in reveals that the addictive potential of DPH can be regarded as proved, based on cases series, eight case reports, a pharmacological overview, one uncontrolled, and one randomized, placebo controlled study. In addition we report a case of an abstinent alcoholic patient treated in our department for DPH-dependency.
Conclusion: Especially when treating patients with a history of addiction, physicians should consider and check the possibility of a DPH dependency.
-
Literatur
- 1 Vernacchio L, Kelly JP, Kaufman DW et al. Cough and cold medication use by US children, 1999 – 2006: Results from the Slone Survey. Pediatrics 2008; 122: e323-329
- 2 Bolden C, Cusack B, Richelson E. Antagonism by antimuscarinic and neuroleptic compounds at the five cloned human muscarinic cholinergic receptors expressed in Chinese hamster ovary cells. J Pharmacol Exp Ther 1992; 260: 576-580
- 3 Glaeske G, Schicktanz C. Barmer GEK Arzneimittelreport 2011: Auswertungsergebnisse der Barmer GEK Arzneimitteldaten aus den Jahren 2009 bis 2010. 1.. Aufl. St. Augustin: Asgard; 2011
- 4 Dilsalver SC. Antimuscarinic agents as substances of abuse: a review. J Clin Psychopharmacology 1988; 8: 14-22
- 5 Schreiber W, Pauls AM, Krieg JC. Toxische Psychose als Akutmanifestation der Diphenhydraminvergiftung. Dtsch med Wochenschr 1988; 113: 180-183
- 6 Lang K, Sigusch H, Müller S. Anticholinergisches Syndrom mit halluzinatorischer Psychose nach Diphenhydramin-Intoxikation. Dtsch med Wochenschr 1995; 120: 1695-1698
- 7 Radovanovic D, Meier PJ, Guirguis M et al. Dose-dependent toxicity of diphenhydramine overdose. Hum Exp Toxicology 2000; 19: 489-495
- 8 Dose M, Tempel HD. Abuse potential of anticholinergics. Pharmacopsychiatry 2000; 33 (Suppl. 01) 43-46
- 9 Anonymous. Is there any evidence that Benylin syrup is addictive?. Br Med J 1979; 1: 459
- 10 Wolf B, Guarino JJ, Preston KL et al. Abuse liability of diphenhydramine in sedative abusers. NIDA Res Monograph 1989; 95: 486-487
- 11 Preston KL, Wolf B, Guarino JJ et al. Subjective and behavioral effects of diphenhydramine, lorazepam and methocarbamol: evaluation of abuse liability. J Pharmacol Exp Ther 1992; 262: 707-720
- 12 Roberts K, Gruer L, Gilhooly T. Misuse of diphenhydramine soft gel capsules (Sleepia): cautionary tale from Glasgow. Addiction 1999; 94: 1575-1577
- 13 Griffiths RR, Johnson MW. Relative abuse liability of hypnotic drugs: A conceptual
framework and algorithm for differentiating among compounds. J Clin Psychiatry 2005;
66: 31-41
MissingFormLabel
- 14 Feldman MD, Behar M. A case of massive diphenhydramine abuse and withdrawal from use of the drug. JAMA 1986; 255: 3119-3120
- 15 MacRury S, Neilson R, Goodwin K. Benylin dependence, metabolic acidosis and hyperglycaemia. Postgrad Med J 1987; 63: 587-588
- 16 de Nesnera AP. Diphenhydramine dependence: a need for awareness. J Clin Psychiatry 1996; 57: 136-137
- 17 Barsoum A, Kolivakis TT, Margolese HC et al. Diphenhydramine (Unisom), a central anticholinergic and antihistaminic: abuse with massive ingestion in a patient with schizophrenia. Can J Psychiatry 2000; 45: 846-847
- 18 Cox D, Ahmed Z, McBride AJ. Diphenhydramine dependence. Addiction 2001; 96: 516-517
- 19 Thomas A, Nallur DG, Jones N et al. Diphenhydramine abuse and detoxification: a brief review and case report. J Psychopharmacol 2009; 23: 101-105
- 20 Lin KH, Chen YJ, Wei CF et al. Prolonges withdrawal delirium in concomitant diphenhydramine and nefopam dependence: A case report. Prog Neuropsychopharmacol Biol Psychiatry 2010; 34: 705-706
- 21 Benson BE, Farooqi MF, Klein-Schwarz W et al. Dephenhydramine dose-response: a novel approach to determine triage thresholds. Clin Toxicol 2010; 48: 820-831
- 22 Poser W, Böning R, Holzbach L et al. Medikamentenabhängigkeit (Sedativa, Hypnotika, Analgetika, Psychostimulanzien). In: Schmidt L, Gastpar M, Falkai P, Gaebel W, Hrsg. Evidenzbasierte Suchtmedizin. Behandlungsleitlinie Substanzbezogene Störungen. Köln: Deutscher Ärzte-Verlag; 2006: 271-300
- 23 Batra A, Buchkremer G. Beziehung von Alkoholismus, Drogen- und Tabakkonsum. Dt Ärztebl 2001; 98: A 2590-2593
- 24 Mathe JM, Nomikos GG, Hildebrand BE et al. Prazosin inhibits MK-801-induced hyperlocomotion and dopamine release in the nucleus accumbens. Eur J Pharmacol 1996; 309: 1-11
- 25 Dringenberg HC, de Souza-Silva MA, Schwarting RKW et al. Increased levels of extracellular dopamine in neostriatum and nucleus accumbens after histamine H1 receptor blockade. Naunyn-Schmiedeberg’s Arch Pharmacol 1998; 358: 423-429
- 26 Kudo Y, Kurihara M. Clinical evaluation of diphenhydramine hydrochloride for the treatment of insomnia in psychiatric patients: a double-blind study. J Clin Pharmacol 1990; 30: 1041-1048
- 27 Weiler JM, Bloomfield JR, Woodworth GG et al. Effects of Fexofenadine, diphenhydramine, and alcohol on driving performance: A randomized, placebo-controlled trial in the Iowa Driving Simulator. Ann Intern Med 2000; 132: 354-363
- 28 Vearrier D, Curtis JA. Case files of the medical toxicology fellowship at Drexel University. Rhabdomyolysis and compartment Syndrome following acute diphenhydramine overdose. J Med Toxicol 2011; 7: 213-219
- 29 Husain Z, Hussain K, Nair R et al. Diphenhydramine induced QT prolongation and torsade de pointes: An uncommon effect of a common drug. Cardiol J 2010; 17: 509-511
- 30 Pragst F, Herre S, Bakdash A. Poisonings with diphenhydramine – a survey of 68 clinical and 55 death cases. Forensic Sci Int 2006; 161: 189-197
- 31 Englert I. Diphenhydraminintoxikation: Anticholinerge Symptomatik, EEG-Befunde im Verlauf und medikamentöse Behandlung bei einem gerontopsychiatrischen Patienten. Psychiat Prax 2004; 31: 145-146