Benadryl linked to increased fall risk

Dear Dr. Roach: I take 25 mg of Benadryl every night to go to sleep. Without it, I get a terrible night’s sleep. I recently read there is a link between Benadryl and dementia. Do you know if there is a correlation?

L.C.

Answer: There is a correlation between certain drugs with anticholinergic properties and dementia. The most common anticholinergics are older antihistamines like diphenhydramine (Benadryl), tricyclic antidepressants like amitriptyline and bladder antispasmodic agents like oxybutynin (Ditropan).

However, the word “correlation” is important, because it is not clear that taking these drugs increases the risk of developing dementia. It may be that people with very early dementia are more likely to be prescribed anticholinergic medications.

I recommend against sleep medications containing Benadryl, primarily because there is a clear increase in risk of car accidents and of falls among people, especially older people, who take these medications.

Newer antihistamines, such as loratadine (Claritin) or cetirizine (Zyrtec), do not have anticholinergic properties, and are a better choice for a person who needs an antihistamine. Similarly, the SSRI class of antidepressants (sertraline (Zoloft) and many others) have far fewer side effects that the older tricyclic class and are used less often. Pelvic floor exercises, bladder retraining and (if appropriate) vaginal estrogen are appropriate treatment for overactive bladder before trying medication.

The observed risk of developing dementia is higher in people taking larger amounts of anticholinergic medication. Although I am not 100% convinced that these medications really do increase risk of dementia, I think there are other reasons to use these drugs at lower doses for shorter periods of time, and to find alternatives if available.

In your case, if behavioral changes to help sleep are not helpful, there are prescription medications available that may be safer than Benadryl in terms of fall risk, and which are not associated with dementia.

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