Does Benadryl Help With Benzodiazepine Withdrawal During a Taper?

Does Benadryl help with benzodiazepine withdrawal?

Benadryl is the brand name for diphenhydramine, an over-the-counter antihistamine sold for allergies. The same ingredient is the active drug in many nighttime sleep aids. So, a person lying awake at 3 am, living through the insomnia of a benzodiazepine taper, may start to wonder about the allergy tablets in the medicine cabinet.

Will Benadryl help? It may bring on drowsiness for a few nights. It does not treat benzodiazepine withdrawal, and it is not a tapering aid.

Why is Benadryl not a tapering aid?

Benzodiazepines act at the receptor for gamma-aminobutyric acid (GABA), the main calming signal in the nervous system. Over time, the nervous system adapts to the drug. Withdrawal is what that adaptation feels like when the dose comes down.

Diphenhydramine works somewhere else. It blocks histamine, one of the signals that keeps the brain awake, and it does nothing at the GABA receptor. It can dim the lights in the room, but the alarm is still ringing.

Professor C. Heather Ashton addressed this in Chapter III of the Ashton Manual, in the section on hypnotics and sedatives. She wrote that if sleep is really a problem, a sedating antihistamine such as Benadryl “may be used temporarily.”

Her next sentence says that antihistamines do not act by the same mechanisms as benzodiazepines. That is why she allowed them where other sleeping pills were ruled out, and why they cannot replace the benzodiazepine. The passage describes a short-term sleep measure, not a way to taper.

Why does Benadryl stop working for sleep after a week or two?

The body gets used to it. For many people who take diphenhydramine every night, the drowsiness fades within one to two weeks, while the side effects can stay. The label on diphenhydramine sleep aids tells the buyer to stop and ask a doctor if sleeplessness continues for more than two weeks.

A benzodiazepine taper takes months, and sometimes longer. So, Benadryl would stop helping long before the taper is over.

The evidence for Benadryl during a taper is limited, and that should be said plainly. Some patients describe a few nights of heavier sleep and a groggy morning after. Others notice nothing at all.

What does the Benadryl label say about taking it with a benzodiazepine?

The Drug Facts label tells buyers to ask a doctor or pharmacist before use if they take sedatives or tranquilizers, and it warns that those drugs may increase drowsiness. A benzodiazepine is exactly that kind of medication. The sedation adds up, which can mean next-day grogginess, unsteadiness, and slower reactions behind the wheel.

Diphenhydramine is also anticholinergic, meaning that it blocks the chemical messenger acetylcholine. That can bring dry mouth, constipation, blurred vision, trouble emptying the bladder, and, especially in older adults, confusion. It is why the label tells people with glaucoma, or with trouble urinating from an enlarged prostate, to ask a doctor first.

Unfortunately, some people get the opposite of sleep. The label warns that excitability may occur, especially in children, and some adults feel wired instead of drowsy. For a nervous system already on edge after a dose reduction, that is a poor trade.

Can anything over the counter make a taper go faster?

No. Nothing sold over the counter lets a taper go faster than the nervous system allows. The pace comes from how the person feels after each reduction, and, as the Maudsley Deprescribing Guidelines describe, the reductions get smaller as the dose gets lower.

Often, the wish to hurry comes from being treated as if the prescription were a bad habit. A person who took a benzodiazepine as prescribed and cannot stop quickly is physically dependent, and physical dependence is not addiction. It is a medical condition, and the way off is a gradual taper that the patient directs.

A sleep aid does not make a fast taper safe, either. The 2020 boxed warning update that the United States Food and Drug Administration (FDA) required on benzodiazepine labels warns that stopping abruptly or reducing the dose too quickly can cause withdrawal reactions, including seizures, that can be life-threatening. Anyone who has a seizure or another medical emergency should call emergency services right away.

When should the prescriber hear about it?

Before the first dose, if possible. Whether an occasional bedtime Benadryl makes sense is a decision for one patient and a physician who understands the pharmacology. The answer depends on age, other medications, and how that person responds, and the same is true of hydroxyzine, the prescription antihistamine.

The prescriber should also hear about nightly use that has gone past two weeks, a dose that is creeping up, or new confusion, trouble urinating, or restlessness. Fortunately, sleep does come back. In the same chapter, Professor Ashton wrote that the need for sleep is so powerful that normal sleep will eventually reassert itself.

The practice of Dr. Mark Leeds, an osteopathic physician and deprescribing specialist in Fort Lauderdale, provides medically supervised benzodiazepine and z-drug tapering for patients in Florida, at a pace the patient directs. Contact the office to ask about a gradual taper.

This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.