Tylenol pm side effects in elderly: Tylenol PM oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

09.11.201808.04.2021 by alexxlab

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Tylenol PM oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Sleeping Pills for Insomnia and Anxiety in Older People

Sleeping pills are usually not the best solution

Almost one-third of older people in the U.S. take sleeping pills. These drugs are called “sedative- hypnotics” or “tranquilizers.” They affect the brain and spinal cord.

Doctors prescribe the drugs for sleep problems. The drugs are also used to treat other conditions, such as anxiety or alcohol withdrawal.

Usually older adults should try nondrug treatments first. According to the American Geriatrics Society, there are safer and better ways to improve sleep or reduce anxiety. Here’s why:

Sleeping pills may not help much.

Many ads say that sleeping pills help people get a full, restful night’s sleep. But studies show that this is not exactly true in real life. On average, people who take one of these drugs sleep only a little longer and better than those who don’t take a drug.

Sleeping pills can have serious, or even deadly side effects.

All sedative-hypnotic drugs have special risks for older adults. Seniors are likely to be more sensitive to the drugs’ effects than younger adults.

And these drugs may stay in their bodies longer.

The drugs can cause confusion and memory problems that:

More than double the risk of falls and hip fractures. These are common causes of hospitalization and death in older people.
Increase the risk of car accidents.

The new “Z” drugs also have risks.

Most ads are for these new drugs. At first, they were thought to be safer. But recent studies suggest they have as much or more risk than the older sleep drugs.

Try treating without medicines first.

Get a thorough medical exam. Sleep problems can be caused by depression or anxiety, pain, restless leg syndrome, and many other conditions. Even if an exam does not turn up an underlying cause, you should try other solutions before you try drugs.

Kinds of sleeping pills

All of these pills have risks, especially for older adults:

Barbiturates

Secobarbital (Seconal and generic)
Phenobarbital (Luminal and generic)

Benzodiazepines
For anxiety:

Alprazolam (Xanax and generic)
Diazepam (Valium and generic)
Lorazepam (Ativan and generic)

For insomnia:

Estazolam (generic only)
Flurazepam (Dalmane and generic)
Quazepam (Doral)
Temazepam (Restoril and generic)
Triazolam (Halcion and generic)

”Z” drugs

Zolpidem (Ambien and generic)
Eszopiclone (Lunesta)
Zaleplon (Sonata and generic)

Over-the-counter drugs may not be a good choice.

Side effects of some drugs can be especially bothersome for seniors: next-day drowsiness, confusion, constipation, dry mouth, and difficulty urinating. Avoid these over-the-counter sleep drugs:

Diphenhydramine (Benadryl Allergy, Nytol, Sominex, and generic)
Doxylamine (Unisom and generic)
Advil PM (combination of ibuprofen and diphenhydramine)
Tylenol PM (combination of acetaminophen and diphenhydramine)

When to try sleeping pills.

Consider these drugs if the sleep problems are affecting your quality of life and nothing else has helped. But your health-care provider should watch you carefully to make sure that the drug is helping and not causing bad side effects.

This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

09/2013

Tylenol PM Uses, Side Effects & Warnings

Generic Name: acetaminophen and diphenhydramine (a SEET a MIN oh fen and DYE fen HYE dra meen)
Brand Name: Headache Relief PM, Legatrin PM, Midol PM, Percogesic Original Strength, Tylenol PM

Medically reviewed by Drugs. com on Sep 29, 2020. Written by Cerner Multum.

What is Tylenol PM?

Acetaminophen is a pain reliever and a fever reducer. Diphenhydramine is an antihistamine.

Tylenol PM is a combination medicine used to treat occasional insomnia associated with minor aches and pains. Tylenol PM is not for use in treating sleeplessness without pain, or sleep problems that occur often.

Tylenol PM is also used to treat minor aches and pains such as headache, back pain, joint or muscle pain, tooth pain, or menstrual cramps.

Tylenol PM is also used to treat runny nose, sneezing, itchy nose and throat, and pain or fever caused by allergies, the common cold, or the flu.

Tylenol PM may also be used for purposes not listed in this medication guide.

Warnings

Use this medicine exactly as directed. An overdose of acetaminophen can damage your liver or cause death. Taking too much diphenhydramine can lead to serious heart problems, seizures, coma, or death.

Do not use this medicine to make a child sleepy. This medicine is not for use in anyone younger than 12 years old.

Ask a doctor or pharmacist before using any other medicine that may contain acetaminophen or diphenhydramine. Taking too much of either medicine can lead to a fatal overdose.

Drinking alcohol may increase your risk of liver damage while taking acetaminophen.

Stop taking this medicine and call your doctor right away if you have skin redness or a rash that spreads and causes blistering and peeling.

Before taking this medicine

Ask a doctor before taking medicine that contains acetaminophen if you have ever had liver disease, or if you drink more than 3 alcoholic beverages per day.

Ask a doctor or pharmacist if Tylenol PM is safe to use if you have ever had:

Ask a doctor before using this medicine if you are pregnant or breastfeeding. Diphenhydramine may slow breast milk production.

How should I take Tylenol PM?

Use exactly as directed on the label, or as prescribed by your doctor. Tylenol PM is only for short-term use until your symptoms clear up.

Do not take more of this medicine than is recommended. An overdose of acetaminophen can damage your liver or cause death. Taking too much diphenhydramine can lead to serious heart problems, seizures, coma, or death.

Tylenol PM is not for use in anyone younger than 12 years old. Do not use the medicine to make a child sleepy. Death can occur from the misuse of antihistamines in very young children.

Do not use this medicine for longer than 2 weeks to treat sleep problems, or longer than 7 days to treat cold or allergy symptoms.

Call your doctor if you still have a fever after 3 days, or you still have pain after 10 days (or 5 days if you are 12-17 years old). Also call your doctor if your symptoms get worse, or if you have any redness or swelling.

If you need surgery or medical tests, tell the doctor ahead of time if you have taken this medicine within the past few days.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Since Tylenol PM is used when needed, you may not be on a dosing schedule. Skip any missed dose if it’s almost time for your next dose. Do not use two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose can be fatal or cause liver damage.

Overdose symptoms may include loss of appetite, vomiting, weakness, confusion, ringing in your ears, upper stomach pain, dark urine, no urination, very dry eyes and mouth, yellowing of your skin or eyes, dilated pupils, fast heartbeats, tremor, agitation, hallucinations, or seizure.

What should I avoid while taking Tylenol PM?

Avoid driving or hazardous activity until you know how Tylenol PM will affect you. Your reactions could be impaired.

Ask a doctor or pharmacist before using any other medicine that may contain acetaminophen or diphenhydramine. This includes medicines for pain, fever, swelling, cold/flu symptoms, or anti-itch medicine used on the skin. Using too much acetaminophen or diphenhydramine can lead to a fatal overdose.

Drinking alcohol may increase your risk of liver damage while taking acetaminophen.

Tylenol PM side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

In rare cases, acetaminophen may cause a severe skin reaction that can be fatal. This could occur even if you have taken acetaminophen in the past and had no reaction. Stop taking this medicine and call your doctor right away if you have skin redness or a rash that spreads and causes blistering and peeling. If you have this type of reaction, you should never again take any medicine that contains acetaminophen.

Stop using the medicine and call your doctor at once if you have:

severe drowsiness;
painful or difficult urination; or
liver problems–loss of appetite, stomach pain (upper right side), tiredness, itching, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Common side effects may include:

drowsiness;
constipation;
decreased urination;
dry eyes, blurred vision; or
dry mouth, nose, or throat.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Tylenol PM?

Ask a doctor or pharmacist before using Tylenol PM with any other medicines, especially drugs that can cause drowsiness (such as opioid medication, sleep medicine, a muscle relaxer, or medicine for anxiety or seizures). Tell your doctor about all your current medicines and any medicine you start or stop using. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Can I give my dad tylenol pm?

The best people to ask will be the patient’s doctor and pharmacist. No one here knows the conditions of your father or your mother, or what medications they are on. No doctor is allowed to almost literally prescribe on the internet, a medication which can have side effects when mixed with other medications, and I would not do so as a lay person.

“Each TYLENOL® PM Extra Strength Caplet and Geltab contains acetaminophen 500 mg and diphenhydramine HCl 25 mg.”

The diphenhydramine HCI is an antihistamine that has sedating qualities. It can cause some medications to increase in blood levels, and sometimes other medications will turn around and do the same to it. If you use it with any medications that are Central Nervous System Depressants, you risk slowing down the patient’s respiration and heart rate. There is also the acetaminophen toxicity to think about. If anyone is already on a med containing this, or someone with liver problems of any sort. Begin by researching medications online, and then take these questions directly to their doctor and pharmacist. I know it’s just an OTC, Over The Counter med and it seems innocuous, but better safe than sorry.

Here is a little bit of info:
“TYLENOL® PM Extra Strength
Liver warning: This product contains acetaminophen. Severe liver damage may occur if you take

more than 4,000 mg of acetaminophen in 24 hours
with other drugs containing acetaminophen
3 or more alcoholic drinks every day while using this product

Do not use

with any other drug containing acetaminophen (prescription or nonprescription). If you are not sure whether a drug contains acetaminophen, ask a doctor or pharmacist
with any other product containing diphenhydramine, even one used on skin
in children under 12 years of age
if you have ever had an allergic reaction to this product or any of its ingredients

Ask a doctor before use if you have

liver disease
a breathing problem such as emphysema or chronic bronchitis
trouble urinating due to an enlarged prostate gland
glaucoma

Ask a doctor or pharmacist before use if you are

taking the blood thinning drug warfarin
taking sedatives or tranquilizers

When using this product

drowsiness will occur
avoid alcoholic drinks
do not drive a motor vehicle or operate machinery

Stop use and ask a doctor if

sleeplessness persists continuously for more than 2 weeks. Insomnia may be a symptom of serious underlying medical illness
pain gets worse or lasts more than 10 days
fever gets worse or lasts more than 3 days
redness or swelling is present
new symptoms occur

These could be signs of a serious condition.

If pregnant or breast-feeding, ask a health professional before use.

Keep out of reach of children.

Overdose warning: In case of overdose, get medical help or contact a Poison Control Center right away (1-800-222-1222). Quick medical attention is critical for adults as well as for children even if you do not notice any signs or symptoms.

PROFESSIONAL INFORMATION: OVERDOSAGE INFORMATION

Acetaminophen: Acetaminophen in massive overdosage may cause hepatic toxicity in some patients. In adults and adolescents (greater than/= 12 years of age), hepatic toxicity may occur following ingestion of greater than 7.5 to 10 grams over a period of 8 hours or less. Fatalities are infrequent (less than 3-4% of untreated cases) and have rarely been reported with overdoses of less than 15 grams. In children (less than 12 years of age), an acute overdosage of less than 150 mg/kg has not been associated with hepatic toxicity. Early symptoms following a potentially hepatotoxic overdose may include: nausea, vomiting, diaphoresis and general malaise. Clinical and laboratory evidence of hepatic toxicity may not be apparent until 48 to 72 hours postingestion. In adults and adolescents, any individual presenting with an unknown amount of acetaminophen ingested or with a questionable or unreliable history about the time of ingestion should have a plasma acetaminophen level drawn and be treated with N-acetylcysteine. For full prescribing information, refer to the N-acetylcysteine package insert. Do not await results of assays for plasma acetaminophen levels before initiating treatment with N-acetylcysteine. The following additional procedures are recommended: Promptly initiate gastric decontamination of the stomach. A plasma acetaminophen assay should be obtained as early as possible, but no sooner than four hours following ingestion. If an acetaminophen extended release product is involved, it may be appropriate to obtain an additional plasma acetaminophen level 4-6 hours following the initial acetaminophen level. If either acetaminophen level plots above the treatment line on the acetaminophen overdose nomogram, N-acetylcysteine treatment should be continued for a full course of therapy. Liver function studies should be obtained initially and repeated at 24-hour intervals. Serious toxicity or fatalities have been extremely infrequent following an acute acetaminophen overdose in young children, possibly because of differences in the way they metabolize acetaminophen. In children, the maximum potential amount ingested can be more easily estimated. If more than 150 mg/kg or an unknown amount was ingested, obtain a plasma acetaminophen level as soon as possible, but no sooner than 4 hours following ingestion. If an acetaminophen extended release product is involved, it may be appropriate to obtain an additional plasma acetaminophen level 4-6 hours following the initial acetaminophen level. If either acetaminophen level plots above the treatment line on the acetaminophen overdose nomogram, N-acetylcysteine treatment should be initiated and continued for a full course of therapy. If an assay cannot be obtained and the estimated acetaminophen ingestion exceeds 150 mg/kg, dosing with N-acetylcysteine should be initiated and continued for a full course of therapy. For additional emergency information, call your regional poison center or call the Rocky Mountain Poison Center toll-free, (1-800-525-6115)

Our adult TYLENOL® combination products contain active ingredients in addition to acetaminophen. The following is basic overdose information regarding those ingredients.

Diphenhydramine: Diphenhydramine toxicity should be treated as you would an antihistamine/anticholinergic overdose and is likely to be present within a few hours after acute ingestion.

For additional emergency information, please contact your local poison control center.

Alcohol Information: Chronic heavy alcohol abusers may be at increased risk of liver toxicity from excessive acetaminophen use, although reports of this event are rare. Reports usually involve cases of severe chronic alcoholics and the dosages of acetaminophen most often exceed recommended doses and often involve substantial overdose. Healthcare professionals should alert their patients who regularly consume large amounts of alcohol not to exceed recommended doses of acetaminophen.”

The Top Drugs for Older Adults to Avoid

Here are 6 classes of medications you may want to avoid. (Photo credit: Getty Images)

Learn which medications are on pharmacists’ ‘black list’

By Patricia Corrigan for Next Avenue

You fill a prescription, a medication you’ve relied on before. A few days later, you experience a troubling side effect. You read online that no one your age should take this medication.

What happened?

Drug Side Effects and Older Adults

Two pharmacists say the aging process is to blame, and they reveal here the names of medications on their “black list” that older adults may want to avoid.

“Prescribing medications for people 65 and older can be more challenging, because some drugs can be more toxic or cause more side effects than when you were younger,” says Kirby Lee, a pharmacist and associate professor of clinical pharmacy at the University of California at San Francisco. “As your body ages, it absorbs medications differently. They can be metabolized differently by your liver and excreted differently by your kidneys, so you may be more sensitive to some medications.”

That’s what happened to me.

Antibiotic Causes Painful Achilles

One recent weekend, I experienced a relapse while on doxycycline, an antibiotic prescribed for a bacterial sinus infection. The doctor on call I spoke with prescribed a stronger antibiotic for me, levofloxacin (Levaquin), one I’d taken successfully a decade ago.

After four days on the new drug, a throbbing Achilles tendon awakened me in the wee hours. I hobbled to the computer and learned the drug is not recommended for people 60 and older. I am 68. Later that morning, I called my internist, who advised me to stop taking it and start helping the tendon to heal — no easy task, and one with no quick fix.

Our aging bodies are not the only challenge. Only about 7,500 physicians in the U.S. specialize in the care of older adults, according to the American Geriatrics Society. With 46 million Americans age 65 and older today, that works out to about one geriatrician per 6,100 patients.

That’s obviously not enough geriatricians now — and by 2060, some 98 million Americans will be 65 and over.

“Until you enter a nursing home or assisted living, you might not see a specialist good at treating older adults, because we don’t yet have a health care system designed to take care of older adults,” says Chad Worz. He is a consultant pharmacist with Medication Managers in Cincinnati and president-elect of the American Society of Consultant Pharmacists (ASCP).

More Assistance from Pharmacists

Based in Alexandria, Va., and with more than 9,000 members, ASCP is said to be the only international professional society devoted to “optimal medication management and improved health outcomes” for older people. Consultant pharmacists work in adult day centers, assisted living facilities, community pharmacies, hospice programs, home care programs, mental health facilities, nursing homes, pharmaceutical companies, physicians’ offices and rehab centers.

On the job, ASCP members evaluate individuals’ medication lists to determine which drugs can be dropped. “In that regard, I am an anti-pharmacist,” Worz says, laughing.

“Every day I look at the records for people on 14 or 15 medications and try to get them to eight or nine. Instead of stopping a drug that causes a certain side effect, doctors often prescribe a drug to fix the side effect,” he says. “I don’t blame the doctors. I blame the system, which does not incentivize patients to have sit-down conversations with doctors or pharmacists about medications.”

Medications You May Want to Avoid

Here are six classes of medications considered especially problematic for older adults:

Benzodiazepines Prescribed — often over-prescribed — for anxiety and sleep disorders, this class of drugs includes diazepam (Valium), lorazepam (Ativan), alpraxolam (Xanax) and chlordiazepoxide (Librium). The medications can cause confusion and greatly increase the risk of falling.

Non-Benzodiazepines Prescribed for insomnia, Zolpidem (Ambien), zaleplon (Sonata) and eszopiclone (Lunesta) are highly addictive and also can cause bizarre sleep behaviors, including sleepwalking.

Anticholinergics Diphenhydramine (Benadryl), acetaminophen with diphenhydramine (Tylenol PM) and some muscle relaxants that contain diphenhydramine (an antihistamine) can cause confusion, constipation, dry mouth, blurry vision or urine retention in older adults. Cumulative exposure to these drugs can lead to dementia.

Nonsteroidal anti-inflammatory drugs Ibuprofen (Motrin), naproxen (Aleve), aspirin and other drugs in this class are “tough on kidneys,” Lee says, and increase the possibility of stomach bleeds. They are not recommended for long-term use. For management of arthritis pain, Lee recommends acetaminophen (Tylenol), physical therapy, acupuncture, aquatic therapy or acupressure.

Antipsychotics This class of drugs is useful to treat significant psychosis or serious mental health conditions, but is too often prescribed for mild agitation, anxiety or depression. Lee suggests taking the lowest effective dose for the shortest term possible. “People get started on these and then they don’t top,” he says.

Old drugs Though barbiturates are rarely prescribed any longer, these sedatives are still available and are highly addictive both physically and psychologically.

Worz notes that blood pressure medications also can cause fatigue or lead to falls.

And he suggests being cautious with the dosage for ranitidine (Zantac), often taken for heartburn. “Taking 150mg twice daily is a normal dose, but in an older person, kidney function may no longer be sufficient to eliminate the drug quickly.” That can lead to possible cognitive issues that can look like dementia.

“Nobody should have to live with a problem that is the result of taking a drug,” Worz adds. “Your doctor or pharmacist usually can find better drugs with fewer side effects to help you.”

For information about other medications that may cause problems for older adults, Worz recommends the “Beers List,” named for the physician who first published the list, which is updated periodically by the American Geriatrics Society.

Why That List of Side Effects Is Important

And what about that antibiotic that caused me so much trouble?

Worz notes that other antibiotics in the same class have been pulled from the market after causing changes in the nervous system, hallucinations and other problems. “Still, it’s impossible to predict exactly how a medication may affect someone, and even a lengthy list of potential side effects may not be specific enough,” he adds.

I can’t be angry with the physician who neglected to take my age into consideration, because I share in the blame.

When I picked up the prescription, I waved off a consultation with the pharmacist, saying I’d taken this antibiotic before. Then, after reading just a sentence or two of the lengthy list provided to me of possible side effects, I tossed the paper into a recycling bin.

That is one of two typical responses, Lee says. “I’ve seen people blow it off — or get so scared they won’t take anything. The information on side effects is based on factual data and written for legal purposes, but it will help you sort out common and less-common side effects, learn what side effects are considered severe and be aware of contraindications.”

Once you read the material, Lee adds, you can weigh the side effects against the benefits of taking the medication. “You also can ask the pharmacist or your doctor what taking the medication might mean for you, and what alternatives there are,” he notes.

Don’t Keep Secrets from Your Doctor

Lee stresses the importance of providing your doctor with an updated list of everything you take, including prescribed medications, over-the-counter drugs and dietary supplements. Also, alert your doctor about any drug allergies or bad reactions to medications you’ve had.

As always, talk to your doctor before you stop taking any prescribed medications. And, remember: no one bit of advice fits all.

“Keep in mind that complications from medications are general trends due to body changes by the time you are 65 or 70,” Lee says. “Some people are likely to experience these complications, but others may have a body that functions like that of a 35-year-old. Always look at your metrics and go from there.”

‍

Some common medications can masquerade as dementia in seniors

By all accounts the woman, in her late 60s, appeared to have severe dementia. She was largely incoherent. Her short-term memory was terrible. She couldn’t focus on questions that medical professionals asked her.

But Dr. Malaz Boustani, a professor of aging research at Indiana University School of Medicine, suspected something else might be going on. The patient was taking Benadryl for seasonal allergies, another antihistamine for itching, Seroquel (an antipsychotic medication) for mood fluctuations, as well as medications for urinary incontinence and gastrointestinal upset.

To various degrees, each of these drugs blocks an important chemical messenger in the brain, acetylcholine. Boustani thought the cumulative impact might be causing the woman’s cognitive difficulties.

He was right. Over six months, Boustani and a pharmacist took the patient off those medications and substituted alternative treatments. Miraculously, she appeared to recover completely. Her initial score on the Mini-Mental State Exam had been 11 of 30 — signifying severe dementia — and it shot up to 28, in the normal range.

An estimated 1 in 4 older adults take anticholinergic drugs — a wide-ranging class of medications used to treat allergies, insomnia, leaky bladders, diarrhea, dizziness, motion sickness, asthma, Parkinson’s disease, chronic obstructive pulmonary disease and various psychiatric disorders.

Older adults are highly susceptible to negative responses to these medications. Since 2012, anticholinergics have been featured prominently on the American Geriatrics Society Beers Criteria list of medications that are potentially inappropriate for seniors.

“The drugs that I’m most worried about in my clinic, when I need to think about what might be contributing to older patients’ memory loss or cognitive changes, are the anticholinergics,” said Dr. Rosemary Laird, a geriatrician and medical director of the Maturing Minds Clinic at AdventHealth in Winter Park, Fla.

Here’s what older adults should know about these drugs:

The Basics

Anticholinergic medications target acetylcholine, an important chemical messenger in the parasympathetic nervous system that dilates blood vessels and regulates muscle contractions, bodily secretions and heart rate, among other functions. In the brain, acetylcholine plays a key role in attention, concentration, and memory formation and consolidation.

Some medications have strong anticholinergic properties, others less so. Among prescription medicines with strong effects are antidepressants such as imipramine (brand name Trofanil), antihistamines such as hydroxyzine (Vistaril and Atarax), antipsychotics such as clozapine (Clozaril and FazaClo), antispasmodics such as dicyclomine (Bentyl) and drugs for urinary incontinence such as tolterodine (Detrol).

In addition to prescription medications, many common over-the-counter drugs have anticholinergic properties, including antihistamines such as Benadryl and Chlor-Trimeton and sleep aids such as Tylenol PM, Aleve PM and Nytol.

Common side effects include dizziness, confusion, drowsiness, disorientation, agitation, blurry vision, dry mouth, constipation, difficulty urinating and delirium, a sudden and acute change in consciousness.

Unfortunately, “physicians often attribute anticholinergic symptoms in elderly people to aging or age-related illness rather than the effects of drugs,” according to a research review by physicians at the Medical University of South Carolina and in Britain.

Seniors are more susceptible to adverse effects from these medications for several reasons: Their brains process acetylcholine less efficiently. The medications are more likely to cross the blood-brain barrier. And their bodies take longer to break down these drugs.

Long-Term Effects

In the late 1970s, researchers discovered that deficits in an enzyme that synthesizes acetylcholine were present in the brains of people with Alzheimer’s disease. “That put geriatricians and neurologists on alert, and the word went out: Don’t put older adults, especially those with cognitive dysfunction, on drugs with acetylcholine-blocking effects,” said Dr. Steven DeKosky, deputy director of the McKnight Brain Institute at the University of Florida.

Still, experts thought that the effects of anticholinergics were short-term and that if older patients stopped taking them, “that’s it — everything goes back to normal,” Boustani said.

Concerns mounted in the mid-2000s when researchers picked up signals that anticholinergic drugs could have a long-term effect, possibly leading to the death of brain neurons and the accumulation of plaques and tangles associated with neurodegeneration.

Since then several studies have noted an association between anticholinergics and a heightened risk of dementia. In late June, this risk was highlighted in a new report in JAMA Internal Medicine that examined more than 284,000 adults age 55 and older in Britain between 2004 and 2016.

The study found that more than half of these subjects had been prescribed at least one of 56 anticholinergic drugs. (Multiple prescriptions of these drugs were common as well.) People who took a daily dose of a strong anticholinergic for three years had a 49% increased risk of dementia. Effects were most pronounced for people who took anticholinergic antidepressants, antipsychotics, antiepileptic drugs and bladder control medications.

These findings don’t constitute proof that anticholinergic drugs cause dementia; they show only an association. But based on this study and earlier research, Boustani said, it now appears older adults who take strong anticholinergic medications for one to three years are vulnerable to long-term side effects.

Preventing Harm

Attention is now turning to how best to wean older adults off anticholinergics, and whether doing so might improve cognition or prevent dementia.

Researchers at Indiana University’s School of Medicine hope to answer these questions in two new studies, starting this fall, supported by $6.8 million in funding from the National Institute on Aging.

One will enroll 344 older adults who are taking anticholinergics and whose cognition is mildly impaired. A pharmacist will work with these patients and their physicians to take them off the medications, and patients’ cognition will be assessed every six months for two years.

The goal is to see whether patients’ brains “get better,” said Noll Campbell, a research scientist at Indiana University’s Regenstrief Institute and an assistant professor at Purdue University’s College of Pharmacy. If so, that would constitute evidence that anticholinergic drugs cause cognitive decline.

The second trial, involving 700 older adults, will examine whether an app that educates seniors about potential harms associated with anticholinergic medications and assigns a personalized risk score for dementia induces people to initiate conversations with physicians about getting off these drugs.

Moving patients off anticholinergic drugs requires “slow tapering down of medications” over three to six months, at a minimum, according to Nagham Ailabouni, a geriatric pharmacist at the University of Washington School of Pharmacy. In most cases, good treatment alternatives are available.

Advice For Older Adults

Seniors concerned about taking anticholinergic drugs “need to approach their primary care physician and talk about the risks versus the benefits of taking these medications,” said Shellina Scheiner, an assistant professor and clinical geriatric pharmacist at the University of Minnesota.

Don’t try stopping cold turkey or on your own. “People can become dependent on these drugs and experience withdrawal side effects such as agitation, dizziness, confusion and jitteriness,” Ailabouni said. “This can be managed, but you need to work with a medical provider.”

Also, “don’t make the assumption that if [a] drug is available over the counter that it’s automatically safe for your brain,” Boustani said. In general, he advises older adults to ask physicians about how all the medications they’re taking could affect their brain.

Finally, doctors should “not give anticholinergic medications to people with any type of dementia,” DeKosky said. “This will not only interfere with their memory but is likely to make them confused and interfere with their functioning.”

Kaiser Health News, a non-profit health newsroom, is an editorially independent part of the Kaiser Family Foundation.

Insomnia and Anxiety in Older People: Sleeping pills are usually not the best solution

Nearly one third of older people in Canada take sleeping pills. These drugs are called “sedative-hypnotics” or “tranquilizers.” They affect the brain and spinal cord.

Health care providers prescribe the drugs for sleep problems. The drugs are also used to treat other conditions, such as anxiety or alcohol withdrawal.

Usually older adults should try non-drug treatments first. There are safer and better ways to improve sleep or reduce anxiety. Here’s why:

Sleeping pills may not help much.

Sleeping pills can have serious, or even deadly side effects.

All sedative-hypnotic drugs have special risks for older adults. Seniors are likely to be more sensitive to the drugs’ effects than younger adults.

And these drugs may stay in their bodies longer.

The drugs can cause confusion and memory problems as well as changes in balance that:

More than double the risk of falls and hip fractures. These are common causes of hospitalization and death in older people.
Increase the risk of car accidents.

The new “Z” drugs also have risks.

“Z” drugs include Zolpidem (Ambien and generic) and Zopiclone (Imovane and generic). Studies suggest they have as much or more risk than the older sleep drugs. There are also concerns they may be as addictive as other sedatives.

Try non-drug treatments first.

Get a thorough medical exam. Sleep problems can be caused by depression or anxiety, pain, restless leg syndrome, and many other conditions.

Even if an exam does not turn up an underlying cause, you should try other solutions before you try drugs (tips for better sleep are found below).

Kinds of sleeping pills (sedative-hypnotics).

All of these pills have risks, especially for older adults:

Benzodiazepines

For anxiety:

Alprazolam (Xanax and generic)
Diazepam (Valium and generic)
Lorazepam (Ativan and generic)

For insomnia:

Flurazepam (Dalmane and generic)
Oxazepam (Serax and generic)
Temazepam (Restoril and generic)
Triazolam (Halcion and generic)

“Z” drugs

Zolpidem (Ambien and generic)
Zopiclone (Imovane and generic)

Sometimes medications under the class antipsychotics or antidepressants are prescribed primarily for sleep including:

Quetiapine (Seroquel and generic)
Trazodone (Desyrel and generic)
Amitryptline (Elavil and generic)

Over-the-counter drugs may not be a good choice.

Side effects of some drugs can be especially bothersome for seniors: next-day drowsiness, confusion, constipation, dry mouth, and difficulty urinating. Avoid these over-the-counter sleep drugs:

Diphenhydramine (Benadryl Allergy, Nytol, Sominex, Gravol, generic)
Advil PM
Tylenol PM

When to try sedative-hypnotic drugs.

Consider these drugs if the sleep problems are affecting your quality of life and nothing else has helped. But your health care provider should watch you carefully to make sure that the drug is helping and not causing bad side effects.

If it is considered necessary, then it should be used at the lowest possible dose and for a limited time.

Tips for better sleep:

Exercise. Physical activity helps people sleep better. But avoid vigorous activity for several hours before bedtime.

Keep a routine. Try to go to bed and wake up at about the same time every day, even on weekends.

Try not to eat right before bedtime. Eat three hours or more before going to bed.

Avoid caffeine after 3 p.m. Some people need to avoid caffeine even earlier.

Limit alcohol. Alcohol causes sleepiness at first, followed by wakefulness.
Create the right environment. Keep the bedroom peaceful. And avoid mental excitement before bedtime.

Avoid bright lights. Watching a bright screen can make you stay awake.

Control pets. Pets disrupt sleep if they are on and off the bed, taking up space, or wanting to be let out.

If you don’t fall asleep soon, get out of bed and do something that will make you sleepy, such as reading. Return to bed after you start to feel drowsy.

Acetaminophen and Diphenhydramine | Memorial Sloan Kettering Cancer Center

This document, provided by Lexicomp ^®, contains all the information you need to know about the drug, including the indications, route of administration, side effects and when you should contact your healthcare provider.

Trade names: USA

Aceta-Gesic [OTC] [DSC]; Acetadryl [OTC]; Excedrin PM [OTC]; GoodSense Pain Relief [OTC]; Goody’s PM [OTC] [DSC]; Legatrin PM [OTC]; Mapap PM [OTC]; Percogesic Extra Strength [OTC]; Tylenol PM Extra Strength [OTC]

What is this drug used for?

Used to treat sleep disorders.
Used to relieve pain and fever.

What should I tell my doctor BEFORE taking this drug?

For all patients taking this drug:

If you are allergic to this drug, any of its ingredients, other drugs, foods or substances. Tell your doctor about your allergy and how it manifested itself.

Children:

If the patient is a child under 12 years of age.Do not give this drug to children younger than 12 years old.

The combination of this drug with certain drugs and diseases can be adverse.

Tell your doctor and pharmacist about all medicines you take (both prescription and over-the-counter, natural products and vitamins) and your health problems. You need to make sure that this drug is safe for your medical conditions and in combination with other drugs you are already taking.Do not start or stop taking any drug or change the dosage without your doctor’s approval.

What do I need to know or do while taking this drug?

All forms of issue:

Tell all healthcare providers that you are taking this drug. These are doctors, nurses, pharmacists and dentists.
Do not take the drug in higher doses than the doctor prescribed.Taking more than the prescribed amount of the drug increases the risk of serious side effects.
Do not use this drug for longer than your doctor prescribed.
Avoid drinking alcohol while taking this drug.
Consult your doctor before using marijuana, other forms of cannabis, prescription or over-the-counter drugs that may slow you down.
This medicine contains acetaminophen. Liver disorders have been reported during acetaminophen use. In some cases, these disorders required liver transplantation or resulted in death. In most cases, liver problems have occurred in patients taking more than 4,000 milligrams (mg) of acetaminophen per day. Often, patients used not one, but several drugs containing acetaminophen.
It is not recommended to use other medicinal products containing acetaminophen.Read the instructions for medicines carefully. Taking too much acetaminophen can lead to liver problems.
Follow the instructions exactly. Do not exceed your prescribed daily dose of acetaminophen. If you are unsure of the daily dose of acetaminophen, ask your doctor or pharmacist for it. Some patients may take this drug in doses of up to 4,000 milligrams (mg) per day as directed by a healthcare professional. Some patients (such as those with liver disease and children) require a lower acetaminophen dose.If you have exceeded your daily dose of acetaminophen, contact your doctor immediately, even if you are not feeling any worse.
Do not use with other preparations containing diphenhydramine.
This drug may interfere with some laboratory tests. Tell all healthcare providers and laboratory staff that you are taking this drug.
If you are 65 years of age or older, use this drug with caution.You may have more side effects.
Tell your doctor if you are pregnant, planning to become pregnant, or breastfeeding. The benefits and risks for you and your child will need to be discussed.

Drugs for the treatment of sleep disorders:

While you are taking this drug, avoid driving vehicles and other activities or activities that require special attention.

All other dosage forms:

Avoid driving or other activities that require increased attention until you see how this drug affects you.

What side effects should I report to my doctor immediately?

WARNING. In rare cases, some people with this drug can have serious and sometimes deadly side effects. Call your healthcare professional or get medical attention right away if you have any of the following signs or symptoms, which may be associated with serious side effects:

Signs of an allergic reaction such as rash, hives, itching, reddened and swollen skin with blistering or scaling, possibly associated with fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue, or throat.
Signs of liver problems such as dark urine, feeling tired, lack of appetite, nausea or abdominal pain, light stools, vomiting, yellowing of the skin and eyes.
Difficulty urinating or change in the amount of urine excreted.
Possible severe skin reaction (Stevens-Johnson syndrome / toxic epidermal necrolysis). This can lead to serious and permanent health problems and sometimes death.Get immediate medical attention if you experience symptoms such as redness, skin swelling with blistering or scaling (with or without a high fever), redness or irritation of the eyes, and ulceration in the mouth, throat, nose, or eyes.

What are some other side effects of this drug?

Any medicine can have side effects. However, many people have little or no side effects.Call your doctor or get medical help if these or any other side effects bother you or do not go away:

Sleepiness.
Nervous tension and agitation.

This list of potential side effects is not exhaustive. If you have any questions about side effects, please contact your doctor. Talk to your doctor about side effects.

You can report side effects to the National Health Office.

You can report side effects to the FDA at 1-800-332-1088. You can also report side effects at https://www.fda.gov/medwatch.

What is the best way to take this drug?

Use this drug as directed by your healthcare practitioner. Read all the information provided to you. Follow all instructions strictly.

All forms of issue:

Take with or without food.Take with food if the medicine causes nausea.

Drugs for the treatment of sleep disorders:

Take this drug before bed.

What should I do if a dose of a drug is missed?

If you are taking this medication regularly, take the missed dose as soon as you can.
If it is time for your next dose, do not take the missed dose and then return to your normal dose schedule.
Do not take 2 doses at the same time or an additional dose.
In most cases, this drug is used as needed. Do not take this medicine more often than prescribed by your doctor.

How do I store and / or discard this drug?

Store at room temperature in a dry place. Do not store in the bathroom.
Store all medicines in a safe place. Keep all medicines out of the reach of children and pets.
Dispose of unused or expired drugs. Do not empty into toilet or drain unless directed to do so. If you have any questions about the disposal of your medicinal products, consult your pharmacist. Your area may have drug recycling programs.

General information on medicinal products

If your health does not improve or even worsens, see your doctor.
You should not give your medicine to anyone and take other people’s medicines.
Some medicines may come with other patient information sheets. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
Some medicines may come with other patient information sheets. Check with your pharmacist. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
If you think an overdose has occurred, call a Poison Control Center immediately or seek medical attention. Be prepared to tell or show which drug you took, how much and when it happened.

Use of information by the consumer and limitation of liability

This information should not be used to make decisions about taking this or any other drug. Only the attending physician has the necessary knowledge and experience to make decisions about which drugs are suitable for a particular patient.This information does not guarantee that the drug is safe, effective, or approved for the treatment of any disease or specific patient. Here are only brief general information about this drug. It does NOT contain all available information on the possible use of the drug with instructions for use, warnings, precautions, information about interactions, side effects and risks that may be associated with this drug. This information should not be construed as a treatment guide and does not replace information provided to you by your healthcare professional.Check with your doctor for complete information on the possible risks and benefits of taking this drug.

Copyright

Tylenol PM Oral: uses, side effects, interactions, pictures, warnings and dosing

Benefits

This combination product contains 2 medicines, acetaminophen and an antihistamine.Acetaminophen helps relieve fever and / or mild to moderate pain (such as headache, back pain, aches / pains due to muscle tension, cold, or flu). The antihistamine in this product can cause drowsiness and therefore can also be used as a night sleep. Antihistamines can also be used to relieve allergy or cold symptoms such as watery eyes, itchy eyes / nose / throat, runny nose, and sneezing.

Cough suppressants were not safe or effective in children under 6 years of age.Therefore, do not use this product to treat symptoms of the common cold in children under 6 years of age unless specifically directed by a doctor. Some products (such as long-acting tablets / capsules) are not recommended for children under 12 years of age. Ask your doctor or pharmacist for more details on the safe use of your product.

These foods do not heal or shorten the duration of the common cold and can cause serious side effects. To reduce the risk of serious side effects, follow all dosage directions carefully.Do not use this product to make your baby sleepy. Do not give other cough and cold medicines that may contain the same or similar ingredients (see also Drug Interactions section) Ask your doctor or pharmacist about other ways to relieve cough and cold symptoms (eg, drinking enough fluids, using humidifier or saline drops / spray).

How to use the Tylenol PM

Tablet

Notes

If your doctor has prescribed this medicine, do not share it with others.

Observe all routine medical and laboratory appointments.

Do not take this product several days before an allergy test as this may affect the test results.

Missed dose

If you are taking this product on a regular basis and miss an appointment, take it as soon as you remember. If it’s close to the time of your next dose, skip the missed dose.Take your next dose at the usual time. Don’t double your dose to catch up.

Storage

Store at room temperature between 59-86 degrees F (15-30 degrees C) away from light and moisture. Do not store in the bathroom. Do not freeze liquid forms of this product. Keep all medicines out of the reach of children and pets.

Do not flush medicines down the toilet or pour them down the drain unless directed to do so. Correctly discard this product when it has expired or is no longer needed.Consult your pharmacist or local waste disposal company for more information on how to safely dispose of your product. The latest information was updated in October 2018. Copyright (c) 2018 First Databank, Inc.

Images

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90,000 instructions for use. Diphenhydramine side effects

Active ingredient

Diphenhydramine

Release form, composition and packaging

Solution for intravenous and intramuscular administration

transparent, colorless.

1 ml – ampoules (10) – cardboard packs.

Pharmacological action

First generation H 1 -histamine receptor blocker. The effect on the central nervous system is due to the blockade of H 3 -histamine receptors in the brain and inhibition of the central cholinergic structures. Relieves spasm of smooth muscles (direct action), reduces capillary permeability, prevents and weakens allergic reactions, has local anesthetic, sedative effects, moderately blocks cholinergic receptors of autonomic ganglia, has a hypnotic effect.Antagonism with histamine is manifested to a greater extent in relation to local vascular reactions in inflammation and allergies than to systemic ones, i.e. decrease in blood pressure. However, with parenteral administration to patients with a deficit in circulating blood volume, a decrease in blood pressure and an increase in the existing hypotension are possible due to the ganglion blocking action. In people with local brain damage and epilepsy, it activates (even in low doses) epileptic discharges on the electroencephalogram and can provoke an epileptic seizure.

The action develops within a few minutes, the duration – up to 12 hours.

Pharmacokinetics

– serum sickness;

– other acute allergic conditions (in combination therapy and in cases where the use of the tablet form is impossible).

Contraindications

– hypersensitivity to diphenhydramine;

– angle-closure glaucoma;

– prostatic hyperplasia;

– peptic ulcer of the stomach and duodenum, complicated by stenosis;

– bladder neck stenosis;

– epilepsy;

– children’s age up to 7 months.

Due to the risk of local necrosis, diphenhydramine should not be used as a local anesthetic.

With care:
, pregnancy, lactation.

Dosage

IV or IM.

For adults and children over 14 years old i / v or i / m 1-5 ml (10-50 mg) 1% solution (10 mg / ml) 1-3 times a day; the maximum daily dose is 200 mg.

For children aged 7 months to 12 months, 0.3-0.5 ml (3-5 mg), from 1 year to 3 years, 0.5-1 ml (5-10 mg), from 4 to 6 years old, 1-1.5 ml (10-15 mg), from 7 to 14 years old, 1.5-3 ml (15-30 mg), if necessary, every 6-8 h.

Side effects

From the nervous system: drowsiness, weakness, decreased psychomotor reaction speed, impaired coordination of movements, dizziness, tremors, irritability, euphoria, agitation (especially in children), insomnia.

From the respiratory system: dryness of the mucous membrane of the mouth, nose, bronchi (increased viscosity of sputum).

From the side of hematopoiesis: hemolytic anemia, thrombocytopenia, agranulocytosis.

From the side of the cardiovascular system: lowering blood pressure, tachycardia, extrasystole.

From the urinary system: urination disorder.

Allergic reactions: urticaria, photosensitivity, skin rash, itching.

Overdose

Symptoms:
depression or excitement (especially in children) of the functions of the central nervous system, depression.Other symptoms of an overdose resemble the action: dilated pupils, dry mouth, dysfunction of the gastrointestinal tract.

Treatment:
There is no specific antidote. Gastric lavage. Blood pressure control. Symptomatic therapy includes drugs that increase blood pressure, oxygen, the introduction of plasma-substituting fluids in / in.

Analeptics cannot be used either.

Drug interaction

Enhances the effect of ethanol and drugs (MP) that depress the central nervous system.

Monoamine oxidase (MAO) inhibitors increase the anticholinergic activity of diphenhydramine.

Description of the drug Diphenhydramine (Diphenhydramine)

Pharmacological group: antihistamines; antiallergic drugs
Effects on receptors: histamine H1 receptors; muscarinic acetylcholine receptors
Systematic (IUPAC) name: 2 – (diphenylmethoxy) -N, N-dimethylethanamine
Trade names: Benadryl, Unisom, Sominex, ZzzQuil, NyQuil
Legal status: Available from pharmacies without a prescription) (S238) (S238) Application: oral, parenteral (intramuscular and intravenous), topically, in the form of suppositories
Bioavailability: 40-60%
Plasma protein binding: 98-99%
Metabolism: various cytochrome P450 enzymes in the liver: CYP2D6 (80%), 3A4 (10%)
Half-life: 8 hours (in children)
9 to 12 hours (in adults)
17 hours (in the elderly)
Excretion: 94% in urine, 6% in faeces
Formula: C 17 H 21 NO
Mol.weight: 255.355 g / mol
Diphenhydramine (abbreviated as DPH, sometimes DHM) is a first generation antihistamine with anticholinergic, antitussive, antiemetic and sedative properties, mainly used for the treatment of allergies. It is also used in the treatment of drug-induced parkinsonism and other extrapyramidal symptoms. The drug has potent hypnotic effects and is FDA-approved as an over-the-counter hypnotic, especially in the form of diphenhydramine citrate.It is manufactured and sold under the brand name Benadryl by McNeil-PPC (a division of Johnson & Johnson) in the United States, Canada and South Africa (trade names in other countries are Diphenhydramine, Daedalon and Nytol). The drug is also available as a generic or private label drug.

Application of Diphenhydramine (Diphenhydramine)

Diphenhydramine is a first generation antihistamine used to treat a range of conditions including allergic symptoms and itching, colds, insomnia, motion sickness and extrapyramidal symptoms.
Diphenhydramine is significantly more effective in treating allergies than newer generation antihistamines. As a result, it is often used when allergic reactions require a rapid, effective anti-histamine mass release agent. Diphenhydramine is available as a drug approved for sale in pharmacies without a prescription Diphenhydramine solution for injection is dispensed only with a doctor’s prescription. Diphenhydramine injections can be used in case of life-threatening reactions (anaphylaxis) to allergens such as bee stings, peanuts or latex, as an adrenaline supplement.
As a potent antagonist of acetylcholine at muscarinic receptors, Diphenhydramine is used to treat extrapyramidal symptoms similar to Parkinson’s disease caused by typical antipsychotic drugs. Muscarinic receptor antagonism corrects levels of dopamine, a neurotransmitter responsible for controlling motor function in the brain, similar to other antimuscarinic drugs such as. Diphenhydramine can cause strong sedation and is also used as an anxiolytic agent.In addition, the drug has been shown to have a mild anti-obsessive effect. Originally developed as a control drug, it actually produces a significant reduction in the symptoms of obsessive-compulsive disorder.
Because of these sedative properties, diphenhydramine is widely used for insomnia as an over-the-counter sleep medication. The maximum recommended dose, as directed by the US FDA, is 50 mg (as hydrochloride salt). The drug is included as an ingredient in several products sold as hypnotics, alone or in combination with other ingredients such as acetaminophen ().An example of the latter is Tylenol PM. Examples of products that include diphenhydramine as the only active ingredient are Unisom, Tylenol Simply Sleep, Nytol, ZzzQuil, and Sominex (version sold in the US and Canada; Promethazine is used in the UK). Tolerance to the sedative effects of Diphenhydramine appears very quickly, after three days of use at a total dosage, the drug is no longer more effective than placebo.
Diphenhydramine also has antiemetic properties, making it useful in relieving the symptoms of motion sickness nausea.Since the drug causes significant sedation in many users, a newer generation of antihistamines, including Loratadine and Dimenhydrinate, may be preferred for use.
Topical diphenhydramine is also available, including in the form of creams, lotions, gels and aerosols. They are used to relieve itching and have the advantage of causing far fewer systemic effects (i.e., drowsiness) than oral forms of the drug. Diphenhydramine also has anesthetic properties when applied topically and is used in patients allergic to general local anesthetics such as lidocaine.

Side effects of Diphenhydramine (Diphenhydramine)

Diphenhydramine is a powerful anticholinergic drug. This effect is responsible for side effects such as dry mouth and throat, increased heart rate, dilated pupils, urinary retention, constipation, and, at high doses, hallucinations or delusions. Other side effects include movement disorders (ataxia), skin redness, visual impairment at the point of close vision due to cycloplegia, abnormal sensitivity to bright light (photophobia), sedation, difficulty concentrating, short-term memory loss, visual impairment. irregular breathing, dizziness, irritability, itching, confusion, decreased body temperature (throughout the body, arms and / or legs), temporary erectile dysfunction, irritability, and although the drug can be used to treat nausea, higher doses may induce vomiting.Some side effects, such as seizures, may be delayed until drowsiness subsides and the person becomes more active.
As a side effect of diphenhydramine, a flutter-flicker effect may appear.
Acute drug poisoning can be fatal, leading to cardiovascular failure and death within 2-18 hours, and is generally treated using symptomatic and supportive approaches. Diagnosis of toxicity is based on medical history and clinical presentation, rather than data on specific levels of the drug in the body.There are several layers of evidence strongly suggesting that diphenhydramine (similar to chlorpheniramine) can block the delayed-rectification potassium channel and, as a consequence, prolong the QT interval, leading to cardiac arrhythmias such as flutter-blinking.
There is no specific antidote to combat Diphenhydramine toxicity, but in cases of severe delirium or tachycardia, the anticholinergic syndrome is treated with Physostigmine.
Some patients may experience an allergic reaction to diphenhydramine in the form of urticaria.Anxiety or akathisia may also appear as a side effect, aggravated by an increased level of diphenhydramine. Since diphenhydramine is extensively metabolized in the liver, individuals with impaired liver function should exercise caution when taking the drug.

Special precautions

Diphenhydramine is not recommended for patients over 60 years of age or children under the age of six without medical advice. These populations should be taking second-generation antihistamines such as Loratadine, Desloratadine, Fexofenadine, Levocetirizine, and Azelastine.Due to its strong anticholinergic effects, Diphenhydramine is on the list of restricted drugs for the elderly.
Diphenhydramine is classified in Category B of the FDA classification for drug safety in pregnancy. Diphenhydramine is also excreted in breast milk. Paradoxical reactions to diphenhydramine have been reported, in particular among children, and it has been shown that, instead of a sedative effect, the drug can cause agitation.

Detection of Diphenhydramine (Diphenhydramine) in the body

The amount of diphenhydramine in blood, plasma or serum can be quantified.Gas chromatography with mass spectrometry (GC-MS) with electron ionization in full scan mode can be used as a screening test. For rapid screening of drug in urine, immunological data based on the principle of competitive binding are used, which can show false-positive results for Methadone in patients using Diphenhydramine. Quantification can be used to monitor therapy, confirm a diagnosis of poisoning in hospitalized patients, provide evidence for a violation of driving rules, or assist in the investigation of death.

Mechanism of action of Diphenhydramine (Diphenhydramine)

Diphenhydramine is an inverse agonist of the histamine h2 receptor. It is a member of the ethanolamine class of antihistamines. By eliminating the effects of histamine on the capillaries, it can reduce the intensity of allergic symptoms. Diphenhydramine also crosses the blood-brain barrier (BBB) and is a centralized h2 receptor antagonist. Its effect on the central h2 receptors causes the effect of drowsiness.
Like many other first generation antihistamines, diphenhydramine is also a potent antimuscarinic drug (a competitive antagonist of muscarinic acetylcholine receptors) and thus may cause anticholinergic syndrome at high doses. Diphenhydramine is used as an antiparkinsonian drug because of its blocking effects on muscarinic acetylcholine receptors in the brain.
Diphenhydramine also acts as an intracellular sodium channel blocker, which is responsible for its action as a local anesthetic.Diphenhydramine inhibits serotonin reuptake. In addition, diphenhydramine is a potentiator of anesthesia induced by the use of morphine in rats.

Pharmacokinetics of Diphenhydramine (Diphenhydramine)

The oral bioavailability of diphenhydramine is in the range of 40-60%, and peak plasma concentrations are observed approximately 2-3 hours after administration. The main metabolic pathway is two successive demethylations of the tertiary amine. The resulting primary amine is further oxidized to a carboxylic acid.The half-life is only 8 hours in children, and up to 17 hours in the elderly.

Recreational use of Diphenhydramine (Diphenhydramine)

Diphenhydramine is sometimes used as a recreational drug, often by people who do not have access to illegal drugs. These people use it for its sedative effect and delusion-induced hallucinations at high doses. Abuse of diphenhydramine can cause:
Euphoria
Dysphoria
Hallucinations (auditory, visual, etc.)
Rapid heartbeat
Excessive sleepiness
Severe dizziness
Speech disorders (slurred, accelerated speech, etc.)
Reflex hyperemia of the skin
Dry mouth and throat
Shivering
Convulsions

Inability to urinate
/ nervousness
Disorientation
Stomach pain
Delirium
To
Death

History

Diphenhydramine was discovered in 1943 by Dr. George Rieveschl, a former professor at the University of Cincinnati.In 1946, the drug becomes the first antihistamine prescription drug approved by the US FDA. Diphenhydramine, N, N-dimethyl- (diphenylmethoxy) ethylamine, was synthesized by a simple reaction of benzhydryl bromide and 2-dimethylaminoethanol.

Synthesis of Diphenhydramine (Diphenhydramine)

In 1960, Diphenhydramine was found to inhibit the reuptake of the neurotransmitter serotonin. This discovery led to the search for a viable antidepressant with a similar structure and fewer side effects, which led to the invention (Prozac), a serotonin reuptake inhibitor (SSRI).A similar search previously led to the synthesis of the first SSRI Zimelidine, from Brompheniramine, which is also an antihistamine.

Society and culture

Diphenhydramine is sometimes used recreationally as a delirium-inducing agent or as a potentiator of the effects of alcohol, opiates, dextromethorphan, and other depressants. Diphenhydramine is believed to have limited abuse potential due to its potentially serious side effects and limited euphoric effects, and is not a controlled substance (in the US).Since 2002, the US FDA has required special warning labels for certain products containing diphenhydramine, as diphenhydramine is often present in posthumous samples collected during investigations of sudden infant deaths; the drug may play a role in these events.
Diphenhydramine is a prohibited and controlled substance in the Republic of Zambia. Travelers are prohibited from bringing this drug into the country. Several Americans have been detained by the Zambian Narcotics Commission for possession of Benadryl and other over-the-counter drugs containing diphenhydramine.

1 ml of solution contains

active substance: diphenhydramine hydrochloride in terms of 100% substance 10 mg,

excipient: water for injection.

Description

Transparent colorless liquid.

Pharmacotherapeutic group

Systemic antihistamines. Aminoalkyl ethers. Diphenhydramine.

ATX code R06AA02

Pharmacological properties

Pharmacokinetics

Plasma protein binding – 98-99%.Most of it is metabolized in the liver, less is excreted unchanged in the urine within 24 hours. The half-life (T1 / 2) is 1-4 hours. It is well distributed in the body, penetrates the blood-brain barrier.
Metabolized primarily in the liver by hydroxylation and conjugation to glucuronides; biotransformation products are eliminated in the urine. It is excreted in mother’s milk and may cause sedation in infants. The maximum activity develops after 1 hour, the duration of action is from 4 to 6 hours.

Pharmacodynamics

I generation h2-histamine receptor blocker eliminates the effects of histamine, which are manifested through this type of receptor. The effect on the central nervous system is due to the blockade of h4-histamine receptors in the brain and inhibition of the central cholinergic structures. Has a pronounced antihistamine activity, reduces or prevents histamine-induced smooth muscle spasms, increased capillary permeability, tissue edema, itching and hyperemia. It causes the effect of local anesthesia (when taken orally, there is a short-term numbness of the mucous membranes of the oral cavity), blocks the cholinergic receptors of the ganglia (lowers blood pressure) and the central nervous system, has sedative, hypnotic, antiparkinsonian and antiemetic effects.Antagonism with histamine is manifested to a greater extent in relation to local vascular reactions in inflammation and allergies than to systemic ones, i.e. lowering blood pressure. However, with parenteral administration to patients with a deficit in circulating blood volume, a decrease in blood pressure and an increase in existing hypotension are possible due to ganglion blocking action. In people with local brain damage and epilepsy, it activates (even in low doses) epileptic discharges on the EEG and can provoke an epileptic seizure.It is more effective in bronchospasm caused by histamine liberators (tubocurarine, morphine), and to a lesser extent in bronchospasm of an allergic nature. The sedative and hypnotic effects are more pronounced with repeated doses.

Indications for use

Anaphylactic shock, urticaria, hay fever, angioedema, allergic conjunctivitis, drug-related allergic reactions

Hemorrhagic vasculitis (capillarotoxicosis)

Serum sickness

Itchy dermatoses, pruritus

Meniere’s disease

Polymorphic exudative erythema

Postoperative vomiting

Method of administration and dosage

The drug is prescribed for adults intramuscularly and intravenously.Do not administer the drug subcutaneously due to irritant effect. When administered intramuscularly, a single dose is 10-50 mg (1-5 ml), the maximum single dose is 50 mg (5 ml), the highest daily dose is 150 mg (15 ml). Intravenously, the drug should be administered drip at a dose of 20-50 mg (2-5 ml) of Diphenhydramine in 100 ml of 0.9% sodium chloride solution. The duration of treatment depends on the achieved effect and the tolerability of the drug.

Side effects

From the nervous system and sensory organs: general weakness, fatigue, sedation, decreased attention, dizziness, drowsiness, headache, impaired coordination of movements, decreased speed of psychomotor reactions, anxiety, increased excitability, fear of death, irritability, nervousness, insomnia, euphoria, confusion, tremors, neuritis, convulsions, paresthesias, dilated pupils, increased intraocular pressure, visual impairment, diplopia, acute labyrinthitis, tinnitus.In patients with local brain lesions or epilepsy, convulsive discharges on the EEG are activated (even with the use of low doses of Diphenhydramine) and the drug can provoke an epileptic seizure.
From the cardiovascular system: arterial hypotension, palpitations, tachycardia, extrasystole.
From the side of the blood system: agranulocytosis, thrombocytopenia, hemolytic anemia.
From the digestive tract: dry mouth, short-term numbness of the oral mucosa, anorexia, nausea, epigastric pain, vomiting, diarrhea, constipation.
From the genitourinary system: frequent and / or difficult urination, urinary retention, early menstruation.

On the part of the respiratory system: dryness of the mucous membrane of the nose and throat, nasal congestion, thickening of the bronchial secretions, a feeling of compression in the chest, shortness of breath, shortness of breath.
From the skin and its derivatives: hyperemia, itching, polymorphic rashes, cyanosis of the skin and mucous membranes.

Allergic reactions: rash, urticaria, anaphylactic shock.

Reactions at the injection site: local necrosis after subcutaneous and intradermal administration.
Others: increased sweating, chills, fever, hyperthermia syndrome, photosensitivity.

Contraindications

Angle-closure glaucoma even in Kazakhstan is in UTI

Prostatic hyperplasia

Stenosing ulcer of the stomach and duodenum

Stenosis of the bladder neck

Epilepsy

Bronchial asthma

Pregnancy and lactation

Hypersensitivity to the drug

Children and adolescents up to 18 years old

Pheochromocytoma

Congenital prolonged QT syndrome or prolonged use of drugs that can prolong the QT interval

Bradycardia

Violation of heart rhythm

Porphyria

Drug interactions “type =” checkbox “>

Drug interactions

Diphenhydramine potentiates the effects of anesthetics, hypnotics, sedatives, narcotic analgesics and local anesthetics.When used with tricyclic antidepressants, it is possible to enhance the anticholinergic and inhibitory effect on the central nervous system. There is a possible risk of seizures when used with analeptics. The simultaneous use of MAO inhibitors and diphenhydramine can lead to an increase in blood pressure, as well as affect the central nervous and respiratory systems. The use of diphenhydramine together with antihypertensive drugs can increase the feeling of fatigue. The drug enhances the effect of ethanol, reduces the effectiveness of apomorphine as an emetic in the treatment of poisoning.Should not be administered concurrently with preparations containing diphenhydramine, including for topical use.

Incompatibility. Do not mix with other medicines in the same container. Use only recommended solvent.

Special instructions

Not recommended for subcutaneous administration. Since Diphenhydramine has an atropine-like effect, it should be used with caution in patients with a history of recent respiratory diseases (including asthma), the same history, I am not now a specific disease of increased intraocular pressure, with hyperthyroidism, diseases of the cardiovascular system, arterial hypotension.It can worsen the course of obstructive pulmonary diseases, severe diseases of the cardiovascular system, ileus, a condition with obstruction of the biliary tract. Diphenhydramine can cause lethargy, as well as cause agitation and hallucinations, convulsions, especially in case of an overdose. Use with caution in patients aged 60 years and older because of the greater likelihood of dizziness, sedation and arterial hypotension.

Use with caution in patients with impaired liver and kidney function.
Avoid UV radiation and alcohol consumption during treatment. Patients need to inform the doctor about the use of this drug: the antiemetic effect can complicate the diagnosis of appendicitis and the recognition of symptoms of overdose with other drugs.

Features of the influence of the drug on the ability to drive a vehicle or potentially dangerous machinery

Since diphenhydramine has sedative and hypnotic effects, during treatment with the drug, one should refrain from potentially hazardous activities that require increased attention and speed of psychomotor reactions.

Diphenhydramine is an antiallergic pharmacological agent that works on the principle of blocking the work of histamine H1 receptors. This drug has been widely used in medicine for the past few decades.

Diphenhydramine is produced in the form of a solution for intravenous and intramuscular injection, placed in ampoules, as well as in the form of tablets for oral administration. Diphenhydramine acts as the main active ingredient in this drug. One milliliter of the drug contains 10 milligrams of this substance (1 percent).Diphenhydramine is available in 1 ml ampoules.

Principle of operation

The action of Diphenhydramine is based on its ability to block H1-histamine receptors and m-cholinergic receptors in the brain. As a result, there is a decrease in the likelihood of smooth muscle spasms occurring against the background of the action of histamines, tissue edema is excluded, the total capillary permeability increases, and itching and swelling are eliminated. Also, the drug is able to work as an anesthetic and sedative with a pronounced hypnotic effect.

In addition, the agent has a certain effect on blood vessels in the event of allergic and inflammatory reactions, which helps to reduce blood pressure indicators. At the same time, the use of this agent by patients with a low blood volume in the circulatory system, there is a possibility of increased symptomatic manifestations of arterial hypotension.

In patients with partial brain damage and epileptic seizures, even when using low doses of the drug, epileptic discharges are noted, which can cause epileptic seizures.

Diphenhydramine has a bioavailability of 50 percent. The highest concentration of the drug in the body, depending on the individual characteristics of the patient, is achieved 20-50 minutes after injection. The highest concentration of the active substance is determined in the tissues of the lungs, kidneys, liver and spleen. The drug has a connection with plasma proteins at a level of 98-99 percent. Diphenhydramine is able to penetrate the blood-brain barrier.

The drug is mainly metabolized in liver cells, and also partially in the kidneys and lungs of humans.The period of elimination from the tissues of internal organs is 6 hours. The half-life is 4 to 10 hours.

In a day, the drug is excreted entirely through the kidneys in the form of metabolites, which are conjugated with glucuronic acid. A fairly significant part of the active substance of the drug is excreted through breast milk, from which it can have a pronounced sedative effect on the child or, conversely, a reverse reaction in the form of excessive overexcitation.

What helps and what contraindications exist

The main indications for the use of Diphenhydramine include:

itching of allergic origin;
, which has arisen against the background of an allergic reaction;
allergic type;
chronic form;
itchy;
dermatographism;
and other allergic reactions of the body.

Diphenhydramine can also be used as a hypnotic sedative in case of sleep disturbance.

Contraindications for the use of liquid diphenhydramine include the following patient conditions:

Individual sensitivity to the individual components of the preparation;
angle-closure glaucoma;
state of prostatic hyperplasia;
stomach ulcer;
bladder stenosis;
chronic epileptic seizures;
high blood pressure.

Instructions for the use of Diphenhydramine in ampoules for adults and children

Diphenhydramine in liquid form is intended for intramuscular and intravenous injection. For children over 12 years of age and adults, this drug is prescribed in a dosage of 10 to 50 mg per day. The maximum daily dose cannot exceed 150 mg. For children under the age of one year, this drug is prescribed in the form of injections with doses of 0.2 to 0.5 milliliters per day. Children aged 2 to 5 years old – 0.5-1.5 milliliters per day, from 6 to 12 years old – 1.5-3 milliliters per day.The interval between injections should be at least 6-8 hours.

Pregnant women are allowed to use this drug only if the benefits of its use outweigh the possible negative consequences for the developing fetus. When breastfeeding while using Diphenhydramine, it is recommended to stop breastfeeding.

In some cases, diphenhydramine in ampoules can be drunk. It should be borne in mind that in order to achieve an effect similar to the tablet form of Diphenhydramine, the total dosage of its liquid form should be increased when using the solution for injection inside.

Diphenhydramine acts as a sleeping pill for 30 minutes, but this time may vary depending on the individual characteristics of the patient’s body.

Overdose and possible adverse reactions

In case of an overdose of Diphenhydramine, excitement or, conversely, depression of the nervous system may occur. This effect is especially pronounced in children. In addition, dryness in the mouth, dilated pupils and problems with the functioning of the digestive system can occur.

In case of exceeding the amount of the administered drug, it is necessary to eliminate the symptomatic manifestations. In the process of eliminating the consequences of an overdose of Diphenhydramine, the use of analeptics and adrenaline is strictly prohibited.

The nervous system, when using Diphenhydramine, can show the following side reactions: fatigue and drowsiness, uncoordinated movements, disturbed sleep patterns, a drop in the speed of mental and motor reactions, constant irritability, tremors of the extremities.

The heart and blood vessels often react as follows: increased heart rate, drop in blood pressure, the development of extrasystole.

There is also a possibility of developing such allergic reactions as: itching and rash on the skin, condition, the appearance of hives.

On the part of the organs involved in hematopoiesis, the following side effects can occur: thrombocytopenia, anemia, and the development of agranulocytosis.

In addition, the use of Diphenhydramine in some patients may cause problems with urination.

Important Information

Diphenhydramine is able to enhance the effect of alcohol and any other drugs that have an effect on the central nervous system. For this reason, you should avoid taking alcoholic beverages while using this medication.

Due to the simultaneous use of Analgin and Diphenhydramine, you can enhance the effect of this agent.

In the presence of chronic diseases of the kidneys and liver, it is important to consult a doctor before taking the medicine to minimize side effects.

The drug Diphenhydramine belongs to the very first generation of effective antihistamines and is included in the list of the most important and vital medicinal substances.

Has a pronounced antihistamine, antiemetic, local anesthetic, antispasmodic and hypnotic effect. When ingested, the substance is well absorbed and has the ability to easily penetrate the placenta and the blood-brain barrier.

In this article, we will consider why doctors prescribe the drug Diphenhydramine, including instructions for use, analogues and prices for this drug in pharmacies.The real REVIEWS of people who have already used Diphenhydramine can be found in the comments.

Form of issue and composition

Diphenhydramine is available in the form of tablets and solution for injection, the active ingredient of which is diphenhydramine. Diphenhydramine solution is available in 1 ml ampoules, 10 ampoules per package; tablets of 0.05 and 0.1 g – in contour packs, 20, 30 or 50 pieces per package.

Clinical and pharmacological group: histamine H1 receptor blocker. Antiallergic drug.

What is diphenhydramine used for?

Indications for the use of this drug include the following allergic pathologies:

urticaria;
hay fever;
allergic rhinitis;
pruritic dermatosis;
allergic conjunctivitis;
as part of complex therapy for anaphylactic shock;
as part of the complex treatment of bronchial asthma;
Allergic complications that develop as a result of the use of certain drugs.

Diphenhydramine in ampoules is used to perform premedication and local anesthesia for people with a history of allergies to various anesthetics.

Pharmacological action

The effect of the drug on the central nervous system is due to the blockade of the H1 receptors in the brain and the inhibitory effect on cholinergic structures.

The use of Diphenhydramine relieves spasm of smooth muscles, weakens allergic reactions, reduces capillary permeability, has a sedative, local anesthetic, hypnotic, antiemetic effect.After an injection of diphenhydramine, its effect develops within a few minutes and lasts up to 12 hours.

Instructions for use

Diphenhydramine tablets, instructions for use suggest the following average dosages:

At 30-50 mg from one to three times a day, the duration of therapy is 10-15 days.
For insomnia, 50 mg is prescribed half an hour before bedtime.
In postencephalic, idiopathic parkinsonism, initially 25 mg is prescribed three times a day, subsequently the dosage is gradually increased to 50 mg 4 times a day.
For motion sickness, 25-50 mg tablets should be taken every 6 hours.

Instructions for the use of Diphenhydramine in ampoules

A solution of Diphenhydramine is injected intravenously with 20-50 mg of the drug, previously dissolved in 100 ml of 0.9 sodium chloride, intramuscular injections are injected once 10-50 mg.

Contraindications

Do not use the drug in such cases:

special sensitivity to the drug and its constituent substances;
breastfeeding;

90,013 children under 2 years old;

angle-closure glaucoma;
prostatic hypertrophy;
ulcer of the stomach and duodenum of the stenosing form;
pyloroduodenal obstruction;
stenosis of the bladder neck;
pregnancy.

Side effects

The following side reactions are possible:

General weakness, psychomotor reaction, increased excitability (especially in children), insomnia, dizziness, visual impairment, dilated pupils, drowsiness, headache, decreased speed, impaired coordination of movements, irritability, tinnitus, photosensitivity, dry eyes. Frequent, difficult urination, urinary retention, thickening of bronchial secretions and difficulty in sputum separation, arterial hypotension are also possible.

On the part of the digestive system, diphenhydramine may cause the following side effects:

Nausea and vomiting;
Constipation or diarrhea;
Epigastric pain;
Dryness of the oral mucosa;
Anorexia.

The use of Diphenhydramine in some cases can cause the development of such side effects from the cardiovascular system, such as lowering blood pressure, tachycardia, palpitations, extrasystoles.

Sometimes the drug causes the following allergic reactions:

Anaphylactic shock;
Urticaria;
Photosensitization;
Medicated rash.
The hematopoietic organs may react to diphenhydramine with thrombocytopenia, hemolytic anemia, or agranulocytosis. On the part of the genitourinary system, when using the drug, urinary retention, difficulty or frequent urination, or early menstruation may develop.

In addition, diphenhydramine may cause chills and increased sweating.

Overdose

If the above rules are not observed and the daily doses of the drug are exceeded, an overdose of “Diphenhydramine” may occur, and it will entail the following symptoms:

Severe dry mouth.
Redness of the skin, in particular of the face.
Shortness of breath.
Confusion of consciousness.
Convulsions.
Lethal outcome.

In case of overdose, it is necessary to urgently wash the stomach, drink activated charcoal and take the patient to the hospital for further treatment.

Special instructions

Use with caution in patients with hyperthyroidism, increased intraocular pressure, diseases of the cardiovascular system, in old age. It should not be used during work by drivers of vehicles and people whose profession is associated with increased concentration of attention. During the period of treatment, you should avoid drinking alcoholic beverages.

Pregnancy and lactation

During pregnancy and lactation (breastfeeding), diphenhydramine is used with caution, according to strict indications, in cases where the expected therapeutic effect for the mother outweighs the potential risk to the fetus or infant.

Analogs

Analogues are Kalmaben, Dramina.

Terms of Sale

With or without prescription? A prescription is required to purchase.

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90,000 Clinical Research Insomnia: Zolpidema Tartrate – Clinical Research Register

Phase 1: Initial Evaluation.

This assessment is conducted at the offices of the Behavioral Sleep Medicine Program (Suite 670, 3535 Market Street Philadelphia, PA 19104) and lasts 1 to 2 hours.Procedures include:

– Completing forms asking about your sleep, mood, alcohol use, medical history, your current medications, and general questions about your age, race, and education.

– Giving your consent to contact your PCP to obtain their consent (consent) that you can safely participate in the trial.

Information obtained during the initial assessment will be used to ensure that you are eligible to participate in this study.If you do not meet the criteria, you will not be able to continue the study, but a referral will be provided if necessary.

NOTE. This study will use the Internet Data Portal (IDP) system to collect most of the survey data. IDP is an electronic data collection system for research and a secure network. It is a password protected site, hosted on Penn’s servers, where the data will live in a database on the Internet that only qualified research personnel have access to.in your initial assessment, you will become familiar with this system and receive a username and research staff will assist you in completing the questionnaires using this IDP. system.

Phase 2: Base period.

This phase lasts 14 days. Your participation includes:

– Completing daily sleep diaries at home. The online diary takes about 5 minutes. every day to complete.

– Completing 6-7 forms asking about your medical symptoms and sleep every week of the base period.It takes about 15 minutes to complete these online forms. full.

– Refrain from using any medications or over-the-counter products that are used specifically to help you fall asleep or fall asleep (eg trazadone / desirel, melatonin, nikvil, Tylenol PM, benadryl, etc.). If you decide to stop taking your current sleeping pills to participate in our study, do so after consulting the doctor who prescribed the sleeping pills for you. Stopping sleep medication will require an extension of the baseline component of our study by at least two weeks.that your insomnia is not of the type, severity, or frequency required for the study, you will not be able to continue to participate in the study, but you will be given a referral. referral will be made to the Penn Sleep Disorder Center. If you or the research staff feel it is yours If two weeks are unusual, you may be offered the opportunity to repeat the baseline period.

Phase 3: Sleep laboratory test (polysomnography) or Home Sleep Apnea Test (HSAT).a polysomnography or HSAT test to determine if you are eligible for the study to continue. During a pandemic, all sleep tests will be done at home. Researchers will decide what type of research you get. enough for 1 night.

The HSAT equipment will be delivered to your home and a member of the research team will contact you. read the instructions for correct use. On the night of the test, you can go to bed in your bed before going to bed, you will attach the sensor (s) according to the instructions and start. After waking up, you will stop the test and remove the sensor (s).On the day immediately after the sleep test, you will ship your device back in a prepaid envelope. Polysomnography procedure: You will be asked to arrive at the sleep laboratory. located at the University of Pennsylvania Hospital (HUP) at the intersection of 34th and Spruce Streets by 7:00 pm for a polysomnographic study (PSG). Upon arrival, urine toxicology tests may be performed to ensure that laboratory measurements are accurate to rule out illicit drug use and are collected to explain the abnormalities found on the PSG.sleep study, based on the results obtained, it will be determined whether re-examination is necessary from both clinical biochemistry and polysomnography. If re-examination is needed, one of the project’s researchers will discuss the substance use problem with you to: (1) determine if the clinical chemistry detection was a mistake (for example, poppy seeds resulted in a positive result) or (2) develop a willingness to abstain from psychoactive use substances for the second time by PSG and until the end of the study.If you scan a positive result a second time, your participation will be terminated.

PSG special procedure requires a set of sensors to be placed on your face, on your scalp and on your body by a technician. All sensors are attached with surgical tape, paste and glue. The sensors on your face are attached to the left and right temples, cheekbones and under the nose. Sensors on the temples and cheekbones measure eye movements associated with falling asleep and dreaming. sensors under the nose measure the flow of air through the mouth and nose.Sensors on the scalp measure brain waves during sleep. the body is located above the collarbones and above the calf muscles. collarbones measure the activity of the heart muscle. sensors above the calf muscles will also measure a strap around the chest and abdomen to measure breathing.

After connecting to the equipment, you must stay in bed until the finale. waking hours the next morning, except for toilet breaks. remote video lab technicians. In the morning you will be woken up by a technician (if necessary), unhooked from the equipment, and then allowed to shower, dress and eat before the rest of the day, you can continue with your normal schedule.

If a PSG or HSAT sleep laboratory test reveals evidence of a sleep disorder other than insomnia, such as sleep apnea, you will not be able to continue the study but will be given a referral.

Phase 4: Standard Treatment. All participants will receive one month of standard treatment. night treatment. If you have a positive response to treatment, you will remain in the study and be randomized to one of the following treatment conditions: overnight dosing, intermittent dosing (1-3 tablets per week, full dose), or one of two variable dose conditions (pills taken at night where any tablet is a variable dose).a process that is like tossing a coin, and neither you nor the teaching staff will know what state you are in (this is called “double blind” You will have an equal chance of being randomized to each of the 4 study groups. Blind in the event of an emergency will be broken and the Investigator and Clinician will advise you of the dosing condition you are prescribed

Standard treatment will last 4 weeks, experimental phase will last more than two weeks.Periods: first – 12 weeks, second – 36 weeks.

Both periods include:

– Taking a pill 30 minutes before bedtime, in one case – 1-3 doses. tablets per week. Otherwise, the pills will be taken every time. night Depending on the specific group to which you are assigned, you will receive 10 mg or 5 mg zolpidem (depending on age and gender) or a variable dose of zolpidem at night basis (range 0 mg to 10 mg at night). Note that zolpidem may be delayed if taken with or immediately after meals.

– Daily filling of a sleep diary;

– Filling out from 6 to 7 questionnaires every week;

– Monthly visit to Pennsylvania to return foil medicine bags and get new foil. a bag of medicine for the next month.

If you do not respond to treatment or (after responding to treatment) you have a relapse of insomnia, you will not be able to continue the study, but will receive the opportunity to take cognitive-behavioral therapy for insomnia (CBT-I) at no cost.An assessment of your clinical status (how your insomnia responds to treatment) will be based on your daily sleep diaries and weekly questionnaires.

During Phase 4, you will be asked to have quarterly health check-ups so that we can optimally monitor our health and wellness.

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Description of the drug Diphenhydramine (Diphenhydramine)

Application of Diphenhydramine (Diphenhydramine)

Side effects of Diphenhydramine (Diphenhydramine)

Special precautions

Detection of Diphenhydramine (Diphenhydramine) in the body

Mechanism of action of Diphenhydramine (Diphenhydramine)

Pharmacokinetics of Diphenhydramine (Diphenhydramine)

Recreational use of Diphenhydramine (Diphenhydramine)

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