 |
|
Cognitive and Other Adverse Effects of Diphenhydramine Use in Hospitalized Older Patients
Joseph V. Agostini, MD;
Linda S. Leo-Summers, MPH;
Sharon K. Inouye, MD, MPH
Arch Intern Med. 2001;161:2091-2097.
Background Diphenhydramine hydrochloride is a commonly prescribed medicine in hospitalized
patients, but its adverse effects on older patients remain unclear.
Methods We enrolled 426 hospitalized medical patients aged 70 years or older
in a prospective cohort study in a university hospital. Measurements included
baseline and daily assessments including Mini-Mental State Examination scores,
Confusion Assessment Method ratings, direct observations for medical devices
(urinary catheter or physical restraints), and blinded medical record extractions
for diphenhydramine use.
Results Of the 426 patients, 114 (27%) received diphenhydramine during hospitalization
and shared similar baseline characteristics including age, sex, delirium risk,
and Mini-Mental State Examination scores compared with nonexposed patients.
The diphenhydramine-exposed group was at an increased risk for any delirium
symptoms (relative risk [RR], 1.7; 95% confidence interval [CI], 1.3-2.3)
and for individual delirium symptoms, including inattention (RR, 3.0; 95%
CI, 1.5-5.9), disorganized speech (RR, 5.5; 95% CI, 1.0-29.8), and altered
consciousness (RR, 3.1; 95% CI, 1.6-6.1). Exposed patients also had increased
risk for urinary catheter placement (RR, 2.5; 95% CI, 1.0-6.0) and longer
median length of stay (7 vs 6 days; P = .009). A
dose-response relationship was demonstrated for most adverse outcomes. Overall,
24% of diphenhydramine doses were administered inappropriately.
Conclusions Diphenhydramine administration in older hospitalized patients is associated
with an increased risk of cognitive decline and other adverse effects with
a dose-response relationship. Careful review of its use is necessary in this
vulnerable population.
From the Departments of Internal Medicine, (Drs Agostini and Inouye)
and Epidemiology and Public Health (Ms Leo-Summers), and the Robert Wood Johnson
Clinical Scholars Program (Dr Agostini), Yale University School of Medicine,
New Haven, Conn.
RELATED LETTER
Association of Diphenhydramine Use With Adverse Effects in Hospitalized Older Patients: Possible Confounders
John R. Meuleman, Joseph V. Agostini, and Sharon K. Inouye
Arch Intern Med. 2002;162(6):720-721.
EXTRACT
| FULL TEXT
RELATED ARTICLE
Archives of Internal Medicine Reader's Choice: Continuing Medical Education
Arch Intern Med. 2001;161(17):2155-2156.
FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Use of drugs with anticholinegic effects and cognitive impairment in community-living older persons
Merchant et al.
Age Ageing 2008;0:afn240v1-afn240.
FULL TEXT
Palliative Care for Patients With Head and Neck Cancer: "I Would Like a Quick Return to a Normal Lifestyle"
Goldstein et al.
JAMA 2008;299:1818-1825.
ABSTRACT
| FULL TEXT
Dementia and Comorbidities: An Overview of Diagnosis and Management
Swanson and Carnahan
Journal of Pharmacy Practice 2007;20:296-317.
ABSTRACT
Risk Factors for Delirium at Discharge: Development and Validation of a Predictive Model
Inouye et al.
Arch Intern Med 2007;167:1406-1413.
ABSTRACT
| FULL TEXT
The effect of delirium education on use of target PRN medications in older orthopaedic patients
Hunter and Cyr
Age Ageing 2007;36:98-101.
FULL TEXT
Evidence-based clinical update: General anesthesia and the risk of delirium and postoperative cognitive dysfunction: [Mise a jour clinique fondee sur des donnees probantes : l'anesthesie generale et le risque de delire et de dysfonctionnement cognitif postoperatoire].
Bryson and Wyand
Canadian J. Anesthesia 2006;53:669-677.
ABSTRACT
| FULL TEXT
Geriatric Syndromes in Elderly Patients Admitted to an Oncology-Acute Care for Elders Unit
Flood et al.
JCO 2006;24:2298-2303.
ABSTRACT
| FULL TEXT
The role of postoperative analgesia in delirium and cognitive decline in elderly patients: a systematic review.
Fong et al.
Anesth. Analg. 2006;102:1255-1266.
ABSTRACT
| FULL TEXT
Association Between Psychoactive Medications and Delirium in Hospitalized Patients: A Critical Review
Gaudreau et al.
Psychosomatics 2005;46:302-316.
ABSTRACT
| FULL TEXT
A Prescribing Cascade Involving Cholinesterase Inhibitors and Anticholinergic Drugs
Gill et al.
Arch Intern Med 2005;165:808-813.
ABSTRACT
| FULL TEXT
Advances in H1-Antihistamines
Simons
NEJM 2004;351:2203-2217.
FULL TEXT
Delirium From the COX-2 Inhibitor Refecoxib
Muralee et al.
Psychosomatics 2004;45:361-363.
FULL TEXT
Adverse Events Due to Discontinuations in Drug Use and Dose Changes in Patients Transferred Between Acute and Long-term Care Facilities
Boockvar et al.
Arch Intern Med 2004;164:545-550.
ABSTRACT
| FULL TEXT
Acute Delirium Associated with Combined Diphenhydramine and Linezolid Use
Serio
The Annals of Pharmacotherapy 2004;38:62-65.
ABSTRACT
| FULL TEXT
Serum Anticholinergic Activity in a Community-Based Sample of Older Adults: Relationship With Cognitive Performance
Mulsant et al.
Arch Gen Psychiatry 2003;60:198-203.
ABSTRACT
| FULL TEXT
Editorial: Hot Topics in Geriatrics
Morley
J. Gerontol. A Biol. Sci. Med. Sci. 2003;58:M30-36.
FULL TEXT
Association of Diphenhydramine Use With Adverse Effects in Hospitalized Older Patients: Possible Confounders
Meuleman et al.
Arch Intern Med 2002;162:720-721.
FULL TEXT
|
