Diphenhydramine in Palliative Care Patients

Q: 74 years old male is converted to hospice care after transfer to ICU due to distant metastases from pancreatic cancer. The patient requested a gentle medicine for proper sleep. Diphenhydramine (Benadryl) is an appropriate choice.

A) True

B) false

Answer: B

The above question intends to cover two objectives.

First, noise pollution in ICUs and inpatient wards is still an underestimated issue. Frequent alarms, ventilator noise, and blood draws at odd hours disrupt patients' sleep patterns and increase the rate of delirium in hospitals.

Non-pharmacological interventions always supersede pharmacological interventions.

The second objective is to underline the abuse of Diphenhydramine for insomnia in hospitals. It is conventionally believed that Diphenhydramine is a benign entity as it is easily available over the counter and is a good sedative to use as a sleep aid. Wrong. Although its antihistamine property makes it a sedative its anticholinergic effect decreases cognitive function and may cause delirium.

There is no reliable data on its use or safety particularly in hospice and palliative care patients.

#end-of-life-care

#pharmacology

Reference:

1. Nolen A, Dai T. Diphenhydramine Use Disorder and Complicated Withdrawal in a Palliative Care Patient. J Palliat Med. 2020 Sep;23(9):1279-1282. doi: 10.1089/jpm.2019.0308. Epub 2019 Dec 5. PMID: 31808723.