But she was surprised by recent headlines highlighting that a growing number of doctors are warning against the use of older antihistamines, such as diphenhydramine, the active ingredient in Benadryl, because of safety and efficacy concerns.
McQuinn says she will no longer buy Benadryl and instead choose from the number of existing alternatives.
"Nobody wants to choose the one that's going to have more negative consequences," she explains.
Long-known side effects from standard doses of Benadryl include sedation, cognitive impairment, and possible heart rhythm abnormalities.
Children are particularly at risk of severe consequences, such as seizures and coma, from too high a dose, and research suggests teens using Benadryl for allergies have lower scores on exams than their peers.
The CSACI statement called on regulators to consider moving Benadryl and other first-generation antihistamines from pharmacy shelves to behind the counter in order to force an interaction with pharmacists who can explain the issues and suggest alternatives.
Pharmacists, however, say the solution isn't so simple: putting Benadryl behind the counter, they say, is not practical and won't resolve the safety concerns. And they have the same concerns about many other over-the-counter drugs.
Consumers would have to speak to a pharmacist, who could decline to provide the medication. But since the drug is approved by
That can create conflict at the drugstore, he adds.
"For many people, the side effect profile isn't a big concern. But if Benadryl were to come on the market today, it might require a prescription, because of the safety profile," he says.
Benadryl's maker,
In a statement,
The agency says that it continues to monitor scientific and medical information as it evolves and would take action if this information required a change to "the regulatory status of products containing diphenhydramine."
Currently, Benadryl is approved for sale without a prescription in locations where a pharmacist is present. This means that it can be sold in pharmacies and certain grocery stores, but not in convenience stores or gas stations.
Nardine Nakhla, a pharmacist who teaches at the
Nakhla says there are also many other drugs, besides diphenhydramine, that have similar risk profiles and are available on pharmacy shelves.
Power agrees that the issue of which drugs belong behind the counter "becomes a bigger question as you start looking (at it)."
In a statement, NAPRA said there is a process to request a change in how it can be sold, but "to date, NAPRA has not received a request regarding diphenhydramine." And, without a request, there is typically no review. Such a request would typically come from the industry, but
Power says it is "very rare" for more restrictions to be placed on an existing over-the-counter medication. "It is much more common to have restrictions loosened."
Dr.
In
And in many countries outside of
Lexchin says that is not surprising. "It may be more effective for one thing than the other, but it's certainly no safer for one thing than the other."
Despite their dispute over where in the pharmacy those Benadryl-like drugs belong, one thing that the allergists and pharmacists agree on is the need for education.
Whether or not diphenhydramine-containing drugs remain over-the-counter or become behind-the-counter access only, Power says the goal to improve safety could be achieved through a "concerted education campaign." He says consumers and health professionals need to understand the benefits, risks, and alternatives to these medications.
— Dr.
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