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Next-day residual sedative effect after nighttime administration of an over-the-counter antihistamine sleep aid, diphenhydramine, measured by positron emission tomography.

Author(s): Zhang D, Tashiro M, Shibuya K, Okamura N, Funaki Y, Yoshikawa T, Kato M, Yanai K

Affiliation(s): Department of Pharmacology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.

Publication date & source: 2010-12, J Clin Psychopharmacol., 30(6):694-701.

Publication type: Comparative Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't

Antihistamines often are self-administered at night as over-the-counter (OTC) sleep aids, but their next-day residual sedative effect has never been evaluated using a reliable quantitative method such as positron emission tomography (PET). We performed a double-blind, placebo-controlled, crossover study in which we evaluated the residual effect the next day after nighttime administration of diphenhydramine, a commonly used OTC sleep aid, in terms of brain H receptor occupancy (HRO) measured using (1)(1)C-doxepin-PET. We also compared the results of diphenhydramine with those of bepotastine, a second-generation antihistamine. Eight healthy adult male subjects underwent PET measurement the morning (11:00) after random oral administration of diphenhydramine (50 mg), bepotastine (10 mg), or placebo the night before (23:00). Binding potential ratios and HROs were calculated in different brain regions of interest such as the cingulate gyrus, frontotemporal cortex, and cerebellum. Subjective sleepiness and plasma drug concentration also were measured. Calculation of binding potential ratios revealed significantly lower values for diphenhydramine than for bepotastine or placebo in all regions of interest (P < 0.01). Cortical mean HRO after diphenhydramine treatment was 44.7% compared with 16.6% for bepotastine treatment (P < 0.01). Subjective sleepiness was not significantly different among the subjects treated with each test drug or the placebo. In conclusion, the next-day residual sedative effect after nighttime administration of the OTC sleep aid diphenhydramine was verified for the first time by direct PET measurement of HRO. Taking into account the possible hangover effect of OTC antihistamine sleep aids, care needs to be taken during their administration.

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