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Deliriants are the least studied class of hallucinogens and display noticeable subjective effects, including dysphoria, hallucinations, and substantial alterations in thought. High doses of diphenhydramine (DPH), an over-the-counter antihistamine medication, can produce deliriant effects due to secondary anticholinergic activity. We sought to characterize the subjective experiences produced by DPH misuse to better understand deliriants more broadly and the context under which DPH misuse occurs. To conduct our analysis, 32 first-hand accounts of DPH misuse publicly available in YouTube videos were analyzed using inductive thematic analysis. Video makers discussed alterations in most sensory modalities, confusion, and a tendency for strongly unpleasant experiences. Occasionally, video makers reported positive effects, although these were rare and often overshadowed by negative aspects of the experience. Video makers frequently warned against misusing DPH, and these individuals occasionally reported adverse post-acute effects. Despite the prevalence of adverse experiences, patterns of repeated misuse were sometimes discussed. Motives for misusing DPH, when mentioned, included accessibility, affordability, and legality. Overall, findings suggest DPH misuse can produce substantial psychoactive effects that are often distressing and share some phenomenological overlap with experiences produced by psychosis. [ABSTRACT FROM AUTHOR]

A sensitive, simple, cost-effective, and eco-friendly method has been suggested for the determination of the drug diphenhydramine (DPH) in pure and pharmaceutical formulations. The method depended on the preparation of the nano-aluminum oxide (Al2O3 NPs) and nano-iron oxide (Fe2O3 NPs) using the Melissa plant extract. The main purpose of this study is to determine the extent of change in electrical potential by using copper wire and aluminum wire, four electrodes were prepared. All electrodes showed Nernstian response, the best response was equal to 57.75 mv/decade for the electrode made from (sodium tetraphenylborate STPB-diphenhydramine) as an ion pair with TBP as a plasticizer and (Al2O3/Fe2O3) NPS with the aluminum wire membrane electrode, also the concentration range was 1.0×10-2 to 1.0×10-8 mole.L-1 with detection limit near to 2.07×10-7 mole.L-1. The value of the correlation coefficient (R²) was 0.9998. In this study, we succeeded in producing nanomaterials from green sources, with applied them in the potentiometric determination of the drug (DPH) to increase the sensitive of the preparation electrodes. These methods have become more desirable because they are characterized by ease of preparation, low cost, and do not use materials harmful to the environment. [ABSTRACT FROM AUTHOR]

Introduction: Early administration of antibiotics for open fractures reduces serious bone and soft tissue infections. The effectiveness of antibiotics in reducing these infections is time-dependent, with various surgical associations recommending administration within one hour of injury, or within one hour of patient arrival to the emergency department (ED). The extent to which prehospital antibiotic administration in these situations might reduce the time to treatment has not been previously reported. The purpose of this study was to describe current prehospital use of antibiotics for traumatic injury, to assess the safety of prehospital antibiotic administration, and to estimate the potential time-savings associated with antibiotic administration by EMS clinicians. Methods: This was a retrospective analysis of the 2019 through 2022 ESO Data Collaborative research data set. Included subjects were patients that had a linked ICD-10 code indicating an open extremity fracture and who received prehospital antibiotics. Time to antibiotic administration was calculated as the elapsed time from EMS dispatch until antibiotic administration. The minimum potential time saved by EMS antibiotic administration was calculated as the elapsed time from administration until ED arrival. To assess safety, epinephrine and diphenhydramine administration were used as proxies for the adverse events of anaphylaxis and minor allergic reactions. Results: There were 523 patients meeting the inclusion criteria. The median (and interquartile range [IQR]) elapsed time from EMS dispatch until antibiotic administration was 31 (IQR: 24-41) minutes. The median potential time savings associated with prehospital antibiotic administration was 15 (IQR: 8-22) minutes. Notably, 144 (27.5%) of the patients who received prehospital antibiotics had total prehospital times exceeding one hour. None of the patients who received antibiotics also received epinephrine for presumed anaphylaxis. Conclusions: EMS clinicians were able to safely administer antibiotics to patients with open fractures a median of 15 min before arrival at the hospital, and 99% of the patients receiving antibiotics had them administered within one hour of EMS dispatch. EMS administration of antibiotics may be a safe way to increase compliance with recommendations for early antibiotic administration for open fractures. [ABSTRACT FROM AUTHOR]

The article discusses the case of a teenage male presenting with severe complications following a multidrug overdose and pulmonary aspiration. Topics discussed include the management of pediatric acute respiratory distress syndrome (ARDS), the use of hemodialysis for metabolic stabilization, and the role of inhaled nitric oxide in addressing refractory hypoxia.

Diphenhydramine (DPH), a commonly used over-the-counter (OTC) antihistamine and sedative, requires accurate and reliable analytical methods to be evaluated in various matrices. The systematic review provides a comprehensive analysis of the current analytical techniques to detect DPH in biological samples and pharmaceutical formulations between 2012 and 2022. Case reports of DPH-related fatalities and intoxications were included along with crime statistics of OTC drug seizure in India from 2017 to 2021. The review also points out gaps in the body of knowledge and recommends areas for future study to provide novel and reliable analytical techniques for detecting DPH. Researchers, analysts, and regulatory bodies engaged in toxicology, drug analysis, and pharmaceutical quality control will find this review's conclusions helpful. [ABSTRACT FROM AUTHOR]

Introduction: Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR) are linked with side effects involving skin and mucosa. Herein, we present a unique case of oral lichenoid drug eruption (LDE) in a patient treated with osimertinib. Case report: A 75-year-old woman was diagnosed with metastatic EGFR-mutated lung adenocarcinoma, and started on osimertinib 80 mg PO daily. At 24 months of therapy, the patient developed a painful, red, and white striated oral lesion involving the left buccal mucosa and the adjacent buccal aspect of gingivae. Biopsy showed oral LDE. Causality assessment between osimertinib and the oral LDE via Naranjo Adverse Drug Reaction probability scale revealed a score of 5. Management and outcome: Osimetinib discontinuation was not felt to be in the best interest of the patient. Therefore, diphenhydramine HCL mouthwash every 6 h PRN (before meals) was started. Spicy and hot foods were discontinued. At a four-week follow-up visit, the patient reported moderate improvement in her symptoms. Conclusion: Oral LDEs are considered premalignant lesions as they can transform into squamous cell carcinoma; therefore, regular follow-up is needed. Awareness of this potential side effect of osimertinib would also prevent unnecessary (and potentially costly) work-up and lead to its prompt diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Introduction: Tricyclic antidepressants often cause drug-induced QRS complex prolongation in overdose but are now less commonly prescribed. We sought to determine, among a contemporary cohort of patients, the pharmaceuticals independently associated with QRS complex prolongation in acute overdose. Methods: We performed secondary analysis of data from the Toxicology Investigators Consortium (ToxIC) Core Registry. We included adult patients presenting from January 2016 through March 2023 with acute or acute-on-chronic pharmaceutical exposures. The primary outcome was QRS complex prolongation >0.12 s. Secondary outcomes included cardiac arrest, death, ventricular dysrhythmia, intensive care unit admission, initiation of vasopressors, and treatment with sodium bicarbonate. We used a multivariable logistic regression model with QRS complex prolongation as the outcome and individual pharmaceuticals of interest as independent variables. We assessed yearly trends of the contribution of relevant pharmaceuticals to QRS complex prolongation since 2016. Results: Of 11,945 patients in the total cohort (median age 37 years, 6,652 [55.7%] female), 366 (3.1%) developed QRS complex prolongation. Of 9,417 patients included in the model, 290 (3.1%) developed QRS complex prolongation. Amitriptyline, nortriptyline, doxepin, imipramine, noxiptiline, bupropion, flecainide, carvedilol, propranolol, diphenhydramine, and lamotrigine poisonings were independent predictors of QRS complex prolongation. Flecainide poisoning conferred the greatest odds of QRS complex prolongation (OR 574.1; 95% CI: 88.3–12,747). The contribution of tricyclic antidepressants to QRS complex prolongation decreased from 38.8% to 17.6% of all patients with QRS complex prolongation from 2016 to 2022. In 2022, the proportion of QRS complex prolongation from diphenhydramine (20.6%) surpassed that of tricyclic antidepressants. Discussion: This study provides insights into contemporary pharmaceutical poisoning associated with QRS complex prolongation. Tricyclic antidepressants remain clinically relevant exposures but are no longer the most common cause of drug-induced QRS complex prolongation. Conclusions: Bupropion, diphenhydramine, and antidysrhythmics are increasingly common causes of QRS complex prolongation, each associated with numerous severe outcomes in poisoning. Greater safety measures to protect patients from cardiovascular toxicity from these pharmaceuticals are warranted. [ABSTRACT FROM AUTHOR]

In continuation of the search for effective, economical, and environmental methods of synthesizing the antihistamine agent diphenhydramine, alkylation of dimethylethanolamine by bromo- (or chloro-)diphenylmethane under phase-transfer catalysis (PTC) conditions and in a microwave oven was studied. The efficiencies of a two-phase liquid(liquid system and a solid-phase(liquid system were compared. The quaternary ammonium salt tetrabutylammonium bromide (TBAB) was used as a catalyst. The proposed microwave irradiation was found to be effective and allowed diphenhydramine to be synthesized in a short time in high yield and purity, suggesting that the proposed method could be used in practice. [ABSTRACT FROM AUTHOR]

Skin inflammatory and allergic conditions often result in symptoms such as erythema, edema, and pruritus, significantly impacting patients' quality of life. Traditional treatment approaches target either the inflammatory or allergic components individually, leaving the accompanying itch inadequately addressed. This study aims to explore the efficacy and safety of a combination therapy using diphenhydramine and lidocaine for managing inflammatory and allergic skin conditions with coexisting itch. Diphenhydramine, a first-generation antihistamine, exhibits potent antiallergic properties by inhibiting histamine receptors (H1). Lidocaine, a local anesthetic, possesses analgesic effects and alleviates pruritus by blocking sensory neurons and reducing capillary permeability. The synergistic effects of diphenhydramine and lidocaine hold promise in providing a comprehensive treatment option for individuals with inflammatory and allergic skin conditions. In this study, the efficacy and safety of combination therapy with diphenhydramine and lidocaine will be evaluated through its effects on symptom relief, inflammatory markers and patient satisfaction. Furthermore, we will analyze dermatoses where the combination therapy used had the best results. The study will also focus on market analysis and formulation availability. This investigation into the diphenhydramine and lidocaine combination therapy represents an innovative approach in dermatology, offering a unique solution for addressing both the underlying inflammation and the troublesome itch associated with inflammatory and allergic skin conditions.

Seasonal allergies have a negative impact on patients' quality of life. Nurses must be aware of the different treatment options and lifestyle modifications to help patients manage their symptoms. This article discusses the benefits and risks of over-the-counter medications for seasonal allergies and other implications for nurses. [ABSTRACT FROM AUTHOR]

Seafood poisoning is common worldwide but is relatively unknown by clinicians and the general public and can be confused with other causes. This article discusses two common seafood poisoning cases--ciguatera and scombroid poisoning--and offers recommended nursing considerations. [ABSTRACT FROM AUTHOR]

Introduction: Allergic reactions caused by external factors are treated with medicinal products containing antihistamines, therefore their action is delayed in time. Combination of antihistamines and fast-acting analgesics may help to reduce discomfort associated with cutaneous reactions. Aim: To evaluate efficacy and safety of the combination topical gel containing diphenhydramine hydrochloride 20 mg/g and lidocaine hydrochloride 10 mg/g over placebo in the treatment of local skin inflammatory and allergic reactions. Material and methods: A study was a single-centre, single-dose, randomized, double-blind, two-treatment, two-period, two-sequence cross-over clinical trial (n = 44) in healthy subjects. Local skin inflammatory and allergic lesions were induced by the provocative test with histamine in healthy subjects. For all parameters recorded with the Visual Analogue Scale (VAS), the area under the curve (AUC) was calculated and the peak itch intensity was noted for every subject in response to the skin prick test. The primary endpoint of the study was the difference in AUC calculated from the intensity of itch for test product A (diphenhydramine hydrochloride 20 mg/g and lidocaine hydrochloride 10 mg/g, gel) and placebo product B. Results: The results revealed that itching intensity AUC was significantly greater for product B than for product A, on average by 2.05 points. A decrease in itching intensity was observed from the second minute after application of the test product. Conclusions: The study provided evidence for differences in efficacy between the product tested and placebo. [ABSTRACT FROM AUTHOR]

Pain relief is a crucial aspect of modern surgery. The analgesic used should possess strong analgesic properties, a rapid onset of action, and minimal side effects to effectively reduce pain during and after surgical procedures. Therefore, the aim of the present study was to evaluate the analgesic effects of diphenhydramine and dipyrone (metamizole) in mice. For this study, 30 mice were randomly divided into five groups: the control group received normal saline; the standard group received 10 mg/kg morphine; treatment group 1 received 2.5 mg/kg diphenhydramine; treatment group 2 received 2.5 mg/kg dipyrone; and treatment group 3 received 2.5 mg/kg diphenhydramine combined with 2.5 mg/kg dipyrone. After injection, pain was assessed using the hot plate test and the formalin test. The results from both tests indicated that the combined use of dipyrone and diphenhydramine produced significant analgesic effects. Additionally, neither dipyrone (metamizole) nor diphenhydramine exhibited any side effects. Therefore, the use of dipyrone (metamizole) and diphenhydramine is recommended for safer surgical procedures. [ABSTRACT FROM AUTHOR]

A 10‐year‐old, neutered male, Golden Retriever dog presented for surgical correction of a descemetocele. Acepromazine (0.02 mg/kg) and methadone (0.5 mg/kg) were administered intramuscularly for sedation, propofol (2 mg/kg) and midazolam (0.2 mg/kg) were administered intravenously for anaesthetic induction and isoflurane in oxygen was utilised for anaesthetic maintenance. Rocuronium (0.5 mg/kg), a neuromuscular blocking agent, was administered intravenously to facilitate central positioning of the eye for surgery. Within 10 min of rocuronium administration, the dog became tachycardic and hypotensive. Hemodynamic aberrations did not resolve with initial interventions but were successfully mitigated with the administration of diphenhydramine (0.8 mg/kg) intravenously. The dog remained stable throughout the remainder of the procedure and experienced a smooth and uneventful recovery. While it is difficult to confirm that the hemodynamic changes observed in this clinical case resulted solely from administration of rocuronium, the observance of the cardiovascular changes, timing of events and response to therapy suggest that rocuronium elicited a histamine response that was successfully treated with diphenhydramine. [ABSTRACT FROM AUTHOR]

A green micellar synchronous spectrofluorimetric method was developed and validated for simultaneous determination of tripelennamine hydrochloride and diphenhydramine in bulk and combined pharmaceutical formulation. Synchronous fluorescence of tripelennamine hydrochloride and diphenhydramine was determined using Δλ = 60 nm. The first derivative of synchronous fluorescence was computed to resolve overlap in the synchronous fluorescence spectra. Tripelennamine hydrochloride was quantified at 375 nm, whereas diphenhydramine was quantified at 293 nm; each is the zero‐crossing point of the other. As diphenhydramine exhibited weak native fluorescence, micelle enhancement upon incorporation of sodium dodecyl sulfate was considered. Two‐level full factorial design was carried out to optimize experimental parameters. Optimum conditions involved using SDS (2% w/v) along with Teorell and Stenhagen buffer (pH 9). The method was found to be linear over the range 0.2–4.5 and 0.2–5 μg/mL for tripelennamine and diphenhydramine, respectively, with limits of detection 0.211 and 0.159 μg/mL. The method was successfully applied for simultaneous determination of tripelennamine hydrochloride and diphenhydramine in laboratory‐prepared gel containing all possible excipients with mean percent recoveries ±SD 100.59 ± 0.79 and 98.99 ± 0.98 for tripelennamine hydrochloride and diphenhydramine, respectively. The proposed method was proved to be eco‐friendly using different greenness assessment tools. [ABSTRACT FROM AUTHOR]

From 2019 to 2020, antihistamines were found in 15% of all US drug overdose deaths, often co-administered with fentanyl, with 3.6% of overdose deaths due to antihistamines alone. The most common antihistamine found in all these reported deaths is diphenhydramine, a ubiquitous, over-the-counter and clinically important medication. Currently, there is no antidote for diphenhydramine overdose. This review summarizes the adverse health effects and current emergency medicine treatments for diphenhydramine. Several emergency medicine case reports are reviewed, and the efficacy and outcomes of a variety of treatments are compared. The treatments reviewed include the more traditional antihistamine overdose therapeutics physostigmine and sodium bicarbonate, as well as newer ones such as donepezil, dexmedetomidine, and lipid emulsion therapy. We conclude that more study is needed to determine the ideal therapeutic approach to treating antihistamine overdoses. [ABSTRACT FROM AUTHOR]

Fatal drug overdoses often involve multiple co-intoxicants, including opioids. Hydrocodone, the most prescribed opioid for pain management, is metabolized to the active metabolite hydromorphone by hepatic CYP2D6. Inhibition of CYP2D6 by other compounds can disrupt the analgesic properties of hydrocodone and extend its half-life. Diphenhydramine is an over-the-counter cold medication and is known to inhibit CYP2D6 activity. A woman in her late 50s was prescribed hydrocodone/acetaminophen (Norco® 10/325). Days before her death, she began taking diphenhydramine for cold symptoms. A post-mortem toxicology report detected the following compounds by High Performance Liquid Chromatography/Time of Flight-Mass Spectrometry (LC/TOF-MS) analysis: acetaminophen (14 μg/mL), hydrocodone (410 ng/mL), dihydrocodeine (24 ng/mL), and diphenhydramine (150 ng/mL). Hydromorphone was not detected (<2 ng/mL). All compounds were detected in therapeutic concentrations, except for hydrocodone, which was present at lethal concentrations. This case highlights a fatal drug-drug interaction between hydrocodone and diphenhydramine. The estimated total body burden of hydrocodone was 6- to 12-fold higher than acetaminophen, which is unexpected, as these two drugs were administered as a single formulation and have similar half-lives. Furthermore, hydromorphone was undetectable. Taken together, these findings are highly suggestive of a fatal opioid overdose precipitated by diphenhydramine. [ABSTRACT FROM AUTHOR]

A quiz is presented about the case of a 25-year-old male who immigrated to New York City from Ecuador one year ago, and with no known past medical history, who presented to the emergency department after an episode of syncope.