IV Benadryl Abuse?

[ohiopharmacist1]

We have a patient who has been getting IV Benadryl the past few months from us for headaches. Is this bull****? The MD doesn't seem concerned about it.

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[Daiphon]

We have a patient who has been getting IV Benadryl the past few months from us for headaches. Is this bull****? The MD doesn't seem concerned about it.

Yes. Bioavailability is nearly equal betwixt PO & IV. Technically speaking, diphenhydramine is part of the "headache cocktail" but added prophylactically to mitigate the antidopaminergic EPS effects of meds like compazine or reglan... and is typically given IV for a myriad of reasons.

But benadryl without the other stuff is silly. Doc might have reasons that I'm unaware of, but it's not something I would do in the ED - and I deal with a lot of headaches (literally & figuratively).

Cheers!
-d

 

[mustang sally]

This is a common practice in our ER. It is often given when the patient complains of a migraine (as part of a combo though; see headache cocktail above) or anxiety.

I sometimes think that the use of it in these situations directly correlates with the MD's suspicions of narc seeking.

 

[rph3664]

Is the physician a neurologist or pain specialist?

 

[ohiopharmacist1]

I work in an outpatient setting and the patient is using IV Benadryl alone for this chronic headache apparently. I can't find any primary literature about this being a reasonable indication for IV Benadryl. The doc is primary care. There's a lot of red flags that point to this patient abusing it, the main one being that the patient constantly gets it filled early.

 

[Dred Pirate]

Agreed with the others, usually part of a cocktail, unless this patient gets migraines so bad that the corresponding nausea doesn't allow her to keep oral meds down? - Basically in this case she is using the benadryl to go to sleep and sleep away the migraine. If it was a neurologist I would be a lot less concerned, but as a PCP - this is not "the norm"

I do remember as a student we had a patient in the same situation and the Rph was a little uneasy

 

[Carboxide]

It absolutely is a drug of abuse when used IV. I have had patients who were straight up addicted to IV Benadryl. If you push it fast, you get a high.

 

[Mad Jack]

It absolutely is a drug of abuse when used IV. I have had patients who were straight up addicted to IV Benadryl. If you push it fast, you get a high.

Benadryl causes a notoriously bad high, of the sort that becoming addicted to it is very rare. It's a consistently awful trip from what I've heard, and one that never gets better, hence why you don't see a bunch of junkies lining up at the drugstores for PO benadryl.

 

[zelman]

Benadryl causes a notoriously bad high, of the sort that becoming addicted to it is very rare. It's a consistently awful trip from what I've heard, and one that never gets better, hence why you don't see a bunch of junkies lining up at the drugstores for PO benadryl.

People respond differently to anticholinergic stupors. it might not be the norm, but this person likely enjoys them.

 

[npage148]

At my other store we had an Artane seaker. Would use a 30 day supply in less than a week and would shop ERs for a 5 day supply. Got to the point we would treating like a CS for him. Anticolenergics man

 

[BidingMyTime]

I have seen that done on an out-patient basis. The person was also on a triptan as well. An out of state specialist had originally prescribed the combo, but then the pt's family doctor prescribed it there on out. So, just because a family doctor is prescribing it, doesn't mean that a neurologist didn't actually make the recommendation. I guess the question is, how much IV Benadryl is the person getting? If the person is having more than 2 - 3 migraines every month, then the person needs to be reevaluated for better treatment options.