Over-the-counter medications containing diphenhydramine and doxylamine used by older adults to improve sleep

Abstract

Background The unintentional misuse of over-the-counter sleep aids among older adults is an important public health problem and a focus of Healthy People 2020. Accordingly, the 2015 Beers Criteria for Potentially Inappropriate Medication Use in Older Adults recommends that individuals 65 years or older avoid use of diphenhydramine and doxylamine; however, many over-the-counter sleep products contain these active ingredients. Objective To identify the proportion of older adults using an over-the-counter medication containing diphenhydramine or doxylamine, and compare their characteristics with older adults using an over-the-counter medication that does not contain these ingredients. Setting Study participants were recruited from the Community Registry of the Pittsburgh Claude D. Pepper Older Americans Independence Center. Method The study sample was taken from a larger survey of 1025 participants on sleep health and over-the-counter sleep medication use conducted from February to April 2015. A subset of 169 participants aged 65 and older reporting taking at least one over-the-counter product to improve sleep within the past 30 days (16.5%) were selected for our analysis on associations between participant characteristics and potentially inappropriate use of over-the-counter sleep medications. Main outcome measure The proportion and characteristics of older adults taking at least one over-the-counter medication containing diphenhydramine or doxylamine. Results Of the 223 over-the-counter sleep medications listed by participants, 115 (52%) contained diphenhydramine or doxylamine. Using the Beers Criteria, we found that more than half of participants (59%) had used a potentially inappropriate over-the-counter medication containing diphenhydramine or doxylamine to improve sleep within the past 30 days. Participants taking at least one diphenhydramine or doxylamine containing medication were less likely to be aware of any safety risks in taking over-the-counter sleep medications than participants not taking these products (38 vs 49%, p = 0.016). Conclusion A majority of older adults in a limited sample from the United States taking an over-the-counter medication to improve sleep are taking a product containing diphenhydramine or doxylamine, both of which are classified as potentially inappropriate for older adults. Awareness of the safety risks of over-the-counter medications and addressing conditions that impact sleep quality could be facilitated through consultation with pharmacists and other healthcare providers.Electronic supplementary materialThe online version of this article (doi:10.1007/s11096-017-0467-x) contains supplementary material, which is available to authorized users.

Assessment of Inhibitory Effects of Hypnotics on Acetylcholine-Induced Contractions in Isolated Rat Urinary Bladder Smooth Muscle

“…Therefore, diphenhydramine is suggested to exert its anticholinergic action within clinically relevant doses, and consequently, suppress UB contraction and induce dysuria. Indeed, it was reported that dysuria was caused by diphenhydramine in a patient with BPH, 20) indicating the appropriateness of our interpretation of our results.…”

“…According to a U.S. survey, many elderly people reportedly take diphenhydramine-containing OTC sleep aids without recognizing the risks associated with their side effects. 21) Based on the results of the present study, upon the sale of diphenhydramine-containing OTC sleep aids, pharmacists and other healthcare providers are recommended to note whether the patients are free from lower urinary symptoms such as BPH, and to carefully explain diphenhydramine's side effects, including dysuria.…”

A critical review of self-care for sleep disturbances: prevalence, profile, motivation, perceived effectiveness and medical provider communication

“…There is evidence to suggest many people with sleep disturbances avoid seeking professional medical help partly due to aforementioned concerns, and as a way for people to maintain a feeling of control over their health (Knauert et al 2015;Venn et al 2013). Adults with sleep disturbances sometimes consider self-care products (such as natural herbs or OTC pharmaceuticals such as Diphenhydramine or Doxylamine) effective alternatives to seeking professional medical help (Meredith et al 2017;Abraham et al 2017) as well as self-care practices including relaxation techniques, yoga and tai chi (Bertisch et al 2009).…”

“…Although in some cases these options are promoted as safer options compared to prescription treatments for certain sleep disturbances, with reduced or no side effects (Fernández-San-Martín et al 2010), there is limited evidence of efficacy and safety, with specific concern about OTC products taken without medical advice (Meredith et al 2017;Abraham et al 2017) particularly in the context of undisclosed concurrent use with medical drugs (Leach and Page 2015). Nonetheless, research suggests that self-care products and practices are utilized more frequently than prescription medications by people with sleep disturbances (Morin et al 2006;Sivertsen et al 2009;Sánchez-Ortuño et al 2009;Worthington and Melia 2006).…”

Translation and Cross-Cultural Adaptation of the Questionnaire of Sleep Health for Using in Chinese Older

“…The questionnaire of sleep health and use of sleep medications among older adults complied by American scholar Olufunmilola Abraham et al [19], it contained 13 items and used to evaluate the use of over-the-counter sleep drugs(over-the-counter,OTC)and prescription sleep drugs among elderly, along with healthcare seeking behaviors, products of the names, frequency of use, knowledge of safety risks and active ingredients, and satisfaction with use sleep medication. The results show that 169 participants from the Pittsburgh Claude D in one urban region of Western Pennsylvania in the United States have all taken sleep medications in the past 30 days, and more than half (59%) of them used OTC drugs containing at least one DIPH/DOX.…”