Can diphenhydramine be taken as a sleeping pill

Abuse of antihistamines

An Over-the-Counter Sleeping Pill Trip

"Finally sleep in! After my surprisingly successful graduation, these were my first words, which I happily spoke to heaven. Finally ignore the morning and make midday my new wake-up time. The prerequisite, of course, was that, admittedly late, falling asleep during the night. But there I should have been excited too soon. Even in the days before graduation, I had severe sleep problems. I paid no attention to them because I was pretty excited about the upcoming graduation ceremony and that was the reason for the sleep problems - at least I told myself that The day before the celebration I bought over-the-counter sleeping pills in the pharmacy (I happened to meet my teacher there; we skilfully ignored each other), at least I wanted to have a good rest during the school year. The tablets didn't fail to work me, how the sleep problems became an integral part of my life. D The tablets also didn't work that great anymore (had already gone through three different brands).

 

One night I was in my bed again trying to fall asleep, but of course I failed miserably. I don't know exactly why I did it. It was probably a mixture of desperation, anger, and curiosity that made me take ten sleeping pills at once. I was aware that I was taking a (calculated) risk because I had no idea how my underweight body would react to it, but I also knew that this dose was clearly too low for suicide. It took about ten minutes for the tablets to take effect. I got dizzy; it was very difficult not to stagger as I walked. As a precaution, I lay down in my bed and turned on music. This dizziness gradually increased, which I noticed when I got up every few minutes to take a quick lap to check the situation.

 

Little by little I had the feeling that someone was practically sucking out my physical strength. I had great difficulty raising my arms, as if they had put on disproportionately much weight in the few minutes. However, I also had a nice feeling. I was totally relaxed, I didn't even know such a beautiful body feeling any more. About 20 minutes after taking it, I was in heaven. I could have lay like this forever. Similar to the feeling you have when you lie in bed in the evening; There is a pleasant tiredness, you know that you are falling asleep at any moment, and you let your thoughts wander again. It's just nice thoughts, just relaxed thoughts. You don't actually want to fall asleep. One is surrounded by happiness.

 

Unfortunately, this atmosphere only lasted a few minutes. Then I asked myself whether I had taken a fatal overdose and what should I do now? The question became a certainty and fear rose in me. Fear of death that was already waiting for me in my sleep. Should I resign like that? Without a word? Without explanation? I still had so much to say, so much to do, and this would be my last night on earth. I mobilized all my strength again and managed to get a writing pad and a pen from my desk. I had to put my final thoughts on paper. I owed that to the people around me. Halfway through the letter my strength ran out; my upper body sank to the mattress and I continued to write the last lines while lying down. As I wrote, my eyes let me down more and more. I couldn't see anything anymore, everything was blurry. With the last of my strength I grabbed my cell phone and texted my best friend. I turned off the light, covered myself up, and waited for sleep; to death. It was strange, on the one hand I was scared, on the other hand I enjoyed this incredible body feeling that was still with me.

 

I didn't sleep much, about two to three hours. I woke up and suddenly saw a fat, white mouse that seemed to be crawling out of my wall. After an incident two years ago, I had developed something like a little phobia of mice, at least the mice that were in my room. I could hardly believe my eyes, but just as quickly as the fat, white mouse appeared, it disappeared again. Unfortunately there were more mice in the room, gray, little bastards that came towards me. I was really scared and threw a little duck cuddly toy at them. But that didn't help. Since I only sleep on a mattress on the floor of my room, the mice would have no problems climbing my pillow paradise. As if stung by a tarantula, I got up and went hunting for mice. I looked under the TV table, under my closet - no mice. As soon as I was back in bed, they were back. My heart was pounding like an opossum; did death come in the form of mice?

 

Sleeping was of course impossible with this mouse epidemic. That's how I ended up spending the night. Irony of fate: I was kept awake by what was supposed to bring me to sleep. At seven o'clock in the morning, confused, I decided to go into the kitchen. I don't even know the reason anymore. I met my mother and found it difficult to speak sensibly. My mouth was numb and dry as dust. So I decided to run senselessly around the house, freeze my ass off and go back to my room. I went into my living room, lay down on the sofa bed and caught up with my sleep there behind the closed door.

 

A mousetrap has been in my room since that night. It wasn't until days later that I realized that the mice were probably hallucinations. Strangely enough, no similar animals appeared after that night. Of course, this experience was on the one hand very cruel and shocking, but on the other hand it showed me how precious life is and that, contrary to my previous attitude, I am very attached to it. I absolutely cannot recommend such a trip. "

 

Antihistamines in the "scene"

This internet report about a trip with "over-the-counter sleeping pills" refers to the active ingredients diphenhydramine and doxylamine, which enjoy constant popularity in the drug scene. These are the following preparations (partly in combination with other active ingredients):

  • Diphenhydramine: Dolestan® , Crescent tablets® , Sedovegan® Novo, Vivinox® Sleep, emesan® , Hevert-Dorm, Betadorm® D et al .;
  • Doxylamine: Hoggar® N, Sedaplus® , SchlafTabs-ratiopharm® , Gittalun® , Wick medinait® , Sleeping stars® i.a.

They are available without a prescription and are therefore of great importance in self-medication. The substances are also "hidden" in numerous flu remedies.

The Federal Institute for Drugs and Medical Devices reported in the summer of 2007 that there were indications of the improper use of diphenhydramine-containing finished drugs by adolescents to induce intoxication. Internet forums recommend a starting dose of around 300 mg (equivalent to six commercially available tablets) to achieve a diphenhydramine trip, but five times the dose (1.5 g) is also swallowed. Mono-poisoning by diphenhydramine in several hundred cases showed mild symptoms at doses of 300 mg or more. Moderate symptoms were seen above 500 mg and severe symptoms occurred above 1 g of diphenhydramine. In addition to the central damping effects described, central stimulation with hallucinations, sleep disorders, cerebral seizures or psychotic reactions such as delusions can occur.

Diphenhydramine intoxication

Diphenhydramine has pronounced anticholinergic properties, especially when it is overdosed. An anticholinergic syndrome can develop. This clinical picture is a serious, life-threatening emergency. Symptoms are severe sedation and a drop in blood pressure up to unconsciousness and respiratory depression, but also fear, restlessness, agitation, hallucinations, disorientation, tremors, palpitations, cardiac arrhythmias and fever. In the case of threatening complications, measures to stabilize the circulation and specific antidote treatment with cholinergics such as physostigmine should be carried out; artificial respiration may be required.

Continuous use can cause kidney damage. Often antihistamines are also combined with dextromethorphan.

Effective spectrum and tolerance development

The H1 -Antihistamines displace the messenger substance histamine from its receptors and were developed for the treatment of hay fever, allergies and nausea. But they have an almost chameleon-like range of effects and indications and are also used as tranquilizers (sedatives), agents against dizziness (anti-vertiginous) and flu remedies. Above all, the older substances in this group have central H.1 Receptors have a strongly sedating and sleep-inducing side effect. For this reason, they are rarely used today for the treatment of allergic reactions. Patients afflicted with hay fever have long since taken fewer sedatives for their runny nose. But how do you get these old remedies to the man or woman anyway? Quite simply: You declare the tired side effect to be the main effect and from then on market these substances as sleeping pills.

But not only people close to the scene are at risk from diphenhydramine or doxylamine. "Normal consumer" can also be affected: After repeated use, there may be a loss of effectiveness (tolerance); Ingestion can lead to the development of physical and psychological dependence, albeit less than with benzodiazepines. The risk of addiction increases with the dose and the duration of use and is even higher in patients with (previous) alcohol, drug or drug addiction. The need for further treatment should therefore be critically examined after two weeks of use at the latest.

Also, do not dispense prescription drugs uncritically

Although their potential for dependence is relatively low, antihistamines must not be used uncritically, as they can lead to numerous side effects and interactions with other drugs and stimulants. With alcohol there is a drastic increase in effectiveness, which has long since got around in scene circles. Pharmacists must therefore be vigilant when a customer asks about these preparations and, if necessary, refuse to dispense them. The risk from diphenhydramine or doxylamine is not to be equated with the risk of long-term use of benzodiazepines. However, under no circumstances should they be given or taken without criticism. The therapy requires special advice. A recommendation without hesitation as an over-the-counter (and therefore harmless?) Drug should be rejected.

Stop tapering off

When diphenhydramine is suddenly stopped, as with benzodiazepines, insomnia may recur temporarily. It is therefore recommended to gradually end the application by halving the dose every week. Depending on the dose and the duration of the misuse or abuse, it may take a few weeks for complete discontinuation. The parallel administration of a herbal sedative can be helpful. After stopping high doses of diphenhydramine for intoxication purposes, a withdrawal syndrome usually occurs with vomiting, abdominal pain, diarrhea and weakness, which may make weaning under medical supervision advisable.

Advice on advice

Basically, patients who receive central depressant drugs must be made aware that even small amounts of alcohol can increase or change the effects of drugs in an unforeseeable way. Increased effects such as sedation, drowsiness and decreased alertness must be expected if alcohol is consumed during treatment. The ability to concentrate (e.g. in traffic) can be severely impaired. In individual cases life-threatening conditions can occur due to cardiovascular disorders and respiratory depression.

And something else should be pointed out to younger pharmacy customers when dispensing: Diphenhydramine is contraindicated during pregnancy. If women take diphenhydramine during the first four months of pregnancy, they are at risk of having children with birth defects. In addition, taking diphenhydramine and benzodiazepines at the same time can be fetoletal. Diphenhydramine should also not be taken during breastfeeding, as it passes into breast milk and inhibits lactation. Sufficient advice potential for us pharmacists ...

 

source 

Pallenbach E. The silent addiction - abuse and dependence on drugs. Scientific publishing company, Stuttgart 2009.

 

 

author

Dr. Ernst Pallenbach,
City Pharmacy Clinic,
Vöhrenbacher Str. 23,
78050 Villingen-Schwenningen