Three Connecticut children died in the last two months after apparently overdosing on an active ingredient in Benadryl.
The deaths were confirmed Monday by the state Office of the Child Advocate (OCA). They come as a so-called “Benadryl Challenge,” which first surfaced in 2020, has re-emerged on social media. The OCA did not confirm if the Connecticut deaths were related to the challenge.
Diphenhydramine, the active ingredient in Benadryl and several other over-the-counter drugs, was responsible for the apparent overdoses, the OCA said.
“Kids, adolescents are taking up to 10 times as much as the recommended doses, because it can elicit some psychedelic effects,” said Dr. Gary Soffer, a pediatrician at the Yale School of Medicine.
“These cases are absolutely at high doses, but there are also long-term implications of using diphenhydramine at regular, appropriate doses as well,” he said.
The Yale pediatric ER no longer administers Benadryl to patients, having switched instead to cetirizine, or Zyrtec, a second-generation antihistamine, Soffer said.
Unlike Benadryl, a first-generation antihistamine, Zyrtec does not cross the blood-brain barrier, and therefore does not lead to the level of drowsiness and sedation caused by Benadryl.
A case for second-generation antihistamines
Sofer co-authored a study published in March in the journal “Pediatrics” examining the use of diphenhydramine in kids.
He and his co-authors found first-generation antihistamines to be associated with adverse short and long-term effects in children. Those side effects include sedation, paradoxical hyperactivity, worse school performance, attention-deficit/hyperactivity disorder and seizures.
In older adults, this class of medications is more likely to be associated with dementia relative to second-generation medication, the authors said.
Dr. Vasanth Kainkaryam, a pediatrician and primary care physician in South Windsor, Connecticut, said while Benadryl works well, it can have side effects including agitation and hallucinations in some children.
“It can make you extremely sleepy, and therefore increases the risk of respiratory issues and overdose,” he said. “Zyrtec, or cetirizine, does not have as much of the side effects that diphenhydramine does.”
A lot of data says Zyrtec can be used instead of Benadryl even for allergic reactions, “and the outcomes seem to be similar,” Kainkaryam said. “So there’s a big push to swap out Benadryl for Zyrtec.”
In a statement, Kenvue, maker of Benadryl, said “our hearts go out to those impacted by the misuse of diphenhydramine-containing products.”
“We take the proper use of our products very seriously and work with nonprofit partners and health care professionals to educate on appropriate use and safe storage of OTC products, including diphenhydramine-containing products.”
Statewide advisory issued to doctors
In an advisory sent to pediatricians statewide June 3, and obtained by Connecticut Public, the Department of Public Health urged providers to advise families to identify and safely store products containing diphenhydramine.
State officials are also urging parents to explore alternative treatments for allergies and related symptoms.
“We want parents to be aware that any medication, including prescription and non-prescription medication, is potentially dangerous to children of all ages,” said Christina Ghio, Connecticut Child Advocate. “We strongly encourage parents to store all medications safely, to ensure they are not easily accessible to children.”
