Understanding the Beers Criteria
Developed by the American Geriatrics Society (AGS), the Beers Criteria is a guideline for healthcare professionals on potentially inappropriate medications (PIMs) for use in older adults. The list identifies medications that are generally best avoided in people 65 and older because they carry a higher risk of adverse effects and may be less effective than alternative treatments. The body's ability to metabolize and clear drugs changes with age, making seniors more susceptible to side effects. The Beers list is a crucial tool for promoting medication safety and is regularly updated to reflect new research.
Why Benadryl is a Concern for Seniors
The active ingredient in Benadryl, diphenhydramine, is a first-generation antihistamine with strong anticholinergic properties. This is the primary reason it is on the Beers list. Anticholinergic drugs block the action of acetylcholine, a neurotransmitter that plays a vital role in the brain's cognitive functions, including learning and memory. As people age, their natural acetylcholine levels decrease, so blocking its action can have significant and dangerous consequences.
Adverse Effects of Benadryl in Older Adults
- Cognitive Impairment: Benadryl can cause confusion, memory problems, and delirium in older adults. Studies have shown a dose-response relationship, with higher doses linked to greater risks.
- Sedation: While often used as a sleep aid, Benadryl's sedating effects can be more intense and prolonged in seniors due to slower drug clearance. This can cause next-day drowsiness and impair daily functioning.
- Increased Fall Risk: The dizziness, sedation, and impaired coordination caused by Benadryl significantly increase the risk of falls and fractures in the elderly, a major public health concern.
- Urinary Retention: The anticholinergic effects can weaken bladder contractions, making it difficult for older adults, particularly men with benign prostatic hyperplasia (BPH), to empty their bladder.
- Other Side Effects: Seniors may also experience dry mouth, blurred vision, and constipation, all of which are linked to Benadryl's anticholinergic effects.
Alternatives to Benadryl for Allergies and Sleep
For seniors who need relief from allergy symptoms or help with occasional sleeplessness, several safer alternatives are available that are not on the Beers list. These options have fewer anticholinergic effects and are therefore less likely to cause cognitive impairment and other severe side effects.
Comparison of Benadryl and Safer Alternatives
| Feature | Diphenhydramine (Benadryl) | Second-Generation Antihistamines | Nasal Sprays |
|---|---|---|---|
| Classification | First-generation antihistamine | Second-generation antihistamine (e.g., Zyrtec, Claritin) | Topical corticosteroids or antihistamines |
| Beers Criteria | Explicitly included, avoid use | Generally safer, preferred alternative | Safer, topical application limits systemic effects |
| Anticholinergic Effects | Strong effects, high risk of side effects | Minimal to no anticholinergic effects | Minimal to no anticholinergic effects |
| Cognitive Impairment | High risk (confusion, memory loss) | Low risk | Low risk |
| Sedation | High risk, prolonged drowsiness | Minimal or non-sedating | None |
| Best For | Acute allergic reactions (under doctor's supervision) | Long-term allergy management | Localized allergy relief (e.g., nasal congestion) |
Expert Recommendations for Older Adults
- Consult Your Healthcare Provider: Before making any medication changes, especially if you have been taking Benadryl for an extended period, talk to a doctor or pharmacist. They can assess your overall health, review all your medications, and recommend the best and safest alternative for your specific needs.
- Use Second-Generation Antihistamines: For managing allergies, over-the-counter second-generation antihistamines like loratadine (Claritin), cetirizine (Zyrtec), or fexofenadine (Allegra) are generally much safer choices for seniors. They do not cross the blood-brain barrier as readily and have fewer side effects.
- Consider Nasal Sprays: For nasal congestion and other localized allergy symptoms, nasal sprays containing corticosteroids (like fluticasone) or topical antihistamines (like azelastine) can provide effective relief with minimal systemic side effects.
- Explore Non-Pharmacological Sleep Aids: If you use Benadryl for sleep, consider discussing non-drug alternatives with your doctor. Poor sleep can have many causes, and addressing the root issue is often more effective than relying on a potentially harmful medication.
The Cumulative Effect of Anticholinergic Drugs
It is important for older adults to be aware of their total anticholinergic burden. Many medications, both prescription and over-the-counter, have anticholinergic effects that can combine to increase the risk of adverse outcomes, including delirium and dementia.
- Medication review is vital to identify and minimize the use of multiple anticholinergic agents.
- Combination cold and flu products often contain diphenhydramine or other first-generation antihistamines. Always read the label carefully before use.
- Be mindful of other medications with anticholinergic properties, such as certain antidepressants, antispasmodics, and bladder control medications.
Conclusion
Yes, oral Benadryl (diphenhydramine) is on the Beers list and should generally be avoided by older adults due to its strong anticholinergic properties and the associated risks of confusion, sedation, and falls. Given the availability of safer and more effective alternatives, it's crucial for seniors and their caregivers to be informed. Always speak with a qualified healthcare professional to review your medications and determine the most appropriate course of action for your health needs. For additional information on medication safety, you can reference the guidelines provided by the American Geriatrics Society.
