From the Guidelines
Hydroxyzine is generally preferred over Benadryl for a 70-year-old patient due to its lower anticholinergic burden and reduced risk of cognitive side effects. For most 70-year-old patients, the choice between Benadryl (diphenhydramine) and hydroxyzine should be based on the specific condition being treated, the patient's overall health status, kidney and liver function, and other medications they may be taking. Benadryl has stronger anticholinergic properties that can cause confusion, urinary retention, dry mouth, blurred vision, and constipation in older adults, and it appears on the Beers Criteria list of medications to avoid in geriatric patients, as discussed in the context of polypharmacy management in older patients 1.
When considering the use of these medications in older adults, it's essential to start with lower doses, such as hydroxyzine 10-25mg or Benadryl 12.5-25mg if necessary, and to be aware of the potential for adverse effects. Non-sedating antihistamines like cetirizine or loratadine might be better alternatives for older patients if appropriate for their condition, especially considering the guidelines for evaluation and management of urticaria in adults and children, which suggest halving the dose of cetirizine, levocetirizine, and hydroxyzine in certain cases 1.
Key considerations for the use of these medications in older adults include:
- Lower anticholinergic burden with hydroxyzine
- Reduced risk of cognitive side effects with hydroxyzine
- Potential for confusion, urinary retention, dry mouth, blurred vision, and constipation with Benadryl
- Importance of starting with lower doses and monitoring for adverse effects
- Consideration of non-sedating antihistamines as alternative options.
From the Research
Comparison of Benadryl and Hydroxyzine for a 70-year-old
- The efficacy and safety of hydroxyzine for sleep in adults, including older adults, have been studied, with mixed results 2.
- Hydroxyzine has been shown to be effective in alleviating symptoms of generalized anxiety disorder, but its use is limited by its side effects, such as sleepiness and drowsiness 3.
- Benadryl (diphenhydramine) is a first-generation antihistamine that has been associated with significant side effects, including sedation, impairment, and increased risk of accidents and mortality 4.
- Newer generation antihistamines are recommended as first-line treatment for allergic rhinitis and urticaria due to their improved safety profile compared to first-generation antihistamines like Benadryl and hydroxyzine 4.
- The pharmacokinetics of diphenhydramine (Benadryl) in patients with end-stage kidney disease have been reviewed, highlighting the need for caution when using this medication in this population due to its potential for toxicity and side effects 5.
- A study comparing the central nervous system effects of cetirizine, hydroxyzine, and diphenhydramine found that hydroxyzine was associated with significant psychomotor impairment and drowsiness 6.
Safety Considerations
- The use of first-generation antihistamines like Benadryl and hydroxyzine is associated with a higher risk of side effects, particularly in older adults 4.
- Hydroxyzine has been shown to be effective for anxiety and sleep, but its use should be carefully considered due to its potential for side effects and interactions with other medications 3, 2.
- Benadryl (diphenhydramine) should be used with caution in older adults due to its potential for toxicity and side effects, particularly in those with kidney disease or other comorbidities 5.