Diphenhydramine, commonly known as Benadryl, is a first-generation antihistamine often used to treat allergies and cold symptoms. It’s important to clarify that Benadryl is not a benzodiazepine (benzo). Benzodiazepines are a class of psychoactive drugs with variable sedative, hypnotic, anxiolytic, anticonvulsant, muscle relaxant and amnesic properties, often prescribed for anxiety and insomnia. While they belong to different drug classes, both Benadryl and benzodiazepines pose significant risks, particularly for older adults.
The concern arises because Benadryl, like benzodiazepines and sedative hypnotics, can have anticholinergic side effects. These effects can lead to confusion and delirium in the short term. Furthermore, research indicates that long-term use of such medications is associated with an increased risk of dementia. Studies have shown a five-fold increase in adverse cognitive events and psychomotor impairment linked to these drugs, significantly elevating the risk of falls in older individuals.
Recognizing these dangers, the 2019 updated Beers Criteria for Potentially Inappropriate Medications for Use in Older Adults specifically identifies these medications as problematic. Expert organizations like the Society for Post-Acute and Long-Term Care Medicine and resources like Choosing Wisely emphasize avoiding diphenhydramine, benzodiazepines, and similar drugs in older populations due to these cognitive and safety risks. This recommendation is based on evidence from randomized controlled trials and extensive geriatric medicine research, highlighting the importance of safer alternatives for managing conditions in older adults.
