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ZzzQuil Disease Interactions

There are 8 disease interactions with ZzzQuil (diphenhydramine).

Major

Anxiolytics/sedatives/hypnotics (applies to ZzzQuil) depression

Major Potential Hazard, Moderate plausibility.

A variety of abnormal thinking and behavior changes have been reported to occur in association with the use of most anxiolytics, sedatives and hypnotics. Some of these changes include decreased inhibition, aggressiveness, agitation, and hallucinations. These drugs can cause or exacerbate mental depression and cause suicidal behavior and ideation. Therapy with these drugs should be administered cautiously in patients with a history of depression or other psychiatric disorders. Patients should be monitored for any changes in mood or behavior. It may be prudent to refrain from dispensing large quantities of medication to these patients.

References

  1. "Product Information. Buspar (buspirone)." Bristol-Myers Squibb (2002):
  2. "Product Information. Ambien (zolpidem)." sanofi-aventis (2001):
  3. "Product Information. Placidyl (ethchlorvynol)." Abbott Pharmaceutical (2001):
  4. "Product Information. Aquachloral Supprettes (chloral hydrate)." Medisca Inc (2001):
  5. "Product Information. Equanil (meprobamate)." Wallace Laboratories (2001):
  6. "Product Information. Sonata (zaleplon)." Wyeth-Ayerst Laboratories (2001):
  7. "Product Information. Precedex (dexmedetomidine)." Abbott Pharmaceutical (2001):
  8. "Product Information. Xyrem (sodium oxybate)." Orphan Medical (2002):
  9. "Product Information. Lunesta (eszopiclone)." Sepracor Inc (2004):
  10. "Product Information. Rozerem (ramelteon)." Takeda Pharmaceuticals America (2005):
  11. "Product Information. Silenor (doxepin)." Somaxon Pharmaceuticals (2010):
  12. "Product Information. Unisom (doxylamine)." Pfizer U.S. Pharmaceuticals Group (2013):
  13. "Product Information. Hetlioz (tasimelteon)." Vanda Pharmaceuticals Inc (2014):
  14. "Product Information. Belsomra (suvorexant)." Merck & Company Inc (2014):
View all 14 references
Moderate

Antihistamines (applies to ZzzQuil) anticholinergic effects

Moderate Potential Hazard, High plausibility. Applicable conditions: Gastrointestinal Obstruction, Urinary Retention, Glaucoma/Intraocular Hypertension

Antihistamines often have anticholinergic activity, to which elderly patients are particularly sensitive. Therapy with antihistamines should be administered cautiously, if at all, in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as urinary retention or obstruction; angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma; and gastrointestinal obstructive disorders. Conventional, first-generation antihistamines such as the ethanolamines (bromodiphenhydramine, carbinoxamine, clemastine, dimenhydrinate, diphenhydramine, doxylamine, phenyltoloxamine) tend to exhibit substantial anticholinergic effects. In contrast, the newer, relatively nonsedating antihistamines (e.g., cetirizine, fexofenadine, loratadine) reportedly have low to minimal anticholinergic activity at normally recommended dosages and may be appropriate alternatives.

References

  1. Schuller DE, Turkewitz D "Adverse effects of antihistamines." Postgrad Med 79 (1986): 75-86
  2. "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories (2002):
  3. "Product Information. Chlortrimeton (chlorpheniramine)." Schering-Plough, Liberty Corner, NJ.
  4. "Product Information. Periactin (cyproheptadine)." Merck & Company Inc (2002):
  5. "Product Information. Benadryl (diphenhydramine)." Parke-Davis (2002):
  6. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories (2001):
  7. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation (2001):
  8. "Product Information. Antivert (meclizine)." Roerig Division (2001):
  9. "Product Information. Marezine (cyclizine)." Glaxo Wellcome (2001):
  10. "Product Information. Optimine (azatadine)." Schering Corporation (2001):
  11. "Product Information. Semprex-D (acrivastine-pseudoephedrine)." Endo Laboratories LLC (2001):
  12. "Product Information. Zyrtec (cetirizine)." Pfizer U.S. Pharmaceuticals (2001):
  13. "Product Information. Drixoral (dextromethorphan)." Schering-Plough (2001):
  14. "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmacal Company (2001):
  15. Alehan FK, Epstein CE, Watemberg NM, Roth KS "Central anticholinergic syndrome on therapeutic doses of cyproheptadine." Pediatrics 103 (1999): 158-60
  16. "Product Information. Vistaril (hydroxyzine)." Pfizer U.S. Pharmaceuticals (2001):
  17. "Product Information. Dramamine (dimenhydrinate)." Pharmacia and Upjohn (2001):
  18. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation (2001):
  19. "Product Information. Temaril (trimeprazine)." Allergan Inc (2001):
  20. Talbert RL, Yee GC, DiPiro JT, Matzke GR, Posey LM, Wells BG "Pharmacotherapy: A Pathophysiologic Approach" Stamford, CT: Appleton & Lange (1999):
View all 20 references
Moderate

Antihistamines (applies to ZzzQuil) asthma/COPD

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Chronic Obstructive Pulmonary Disease

It has been suggested that the anticholinergic effect of antihistamines may reduce the volume and cause thickening of bronchial secretions, resulting in obstruction of respiratory tract. Some manufacturers and clinicians recommend that therapy with antihistamines be administered cautiously in patients with asthma or chronic obstructive pulmonary disease.

References

  1. "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories (2002):
  2. "Product Information. Chlortrimeton (chlorpheniramine)." Schering-Plough, Liberty Corner, NJ.
  3. "Product Information. Periactin (cyproheptadine)." Merck & Company Inc (2002):
  4. "Product Information. Benadryl (diphenhydramine)." Parke-Davis (2002):
  5. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories (2001):
  6. Maddox DE, Reed CE "Clinical pharmacodynamics of antihistamines." Ann Allergy 59 (1987): 43-8
  7. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation (2001):
  8. "Product Information. Antivert (meclizine)." Roerig Division (2001):
  9. "Product Information. Marezine (cyclizine)." Glaxo Wellcome (2001):
  10. "Product Information. Optimine (azatadine)." Schering Corporation (2001):
  11. "Product Information. Semprex-D (acrivastine-pseudoephedrine)." Endo Laboratories LLC (2001):
  12. "Product Information. Drixoral (dextromethorphan)." Schering-Plough (2001):
  13. "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmacal Company (2001):
  14. "Product Information. Vistaril (hydroxyzine)." Pfizer U.S. Pharmaceuticals (2001):
  15. "Product Information. Dramamine (dimenhydrinate)." Pharmacia and Upjohn (2001):
  16. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation (2001):
  17. "Product Information. Temaril (trimeprazine)." Allergan Inc (2001):
View all 17 references
Moderate

Antihistamines (applies to ZzzQuil) cardiovascular

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Cardiovascular Disease, Hyperthyroidism, Hypotension

Antihistamines may infrequently cause cardiovascular adverse effects related to their anticholinergic and local anesthetic (quinidine-like) activities. Tachycardia, palpitation, ECG changes, arrhythmias, hypotension, and hypertension have been reported. Although these effects are uncommon and usually limited to overdosage situations, the manufacturers and some clinicians recommend that therapy with antihistamines be administered cautiously in patients with cardiovascular disease, hypertension, and/or hyperthyroidism.

References

  1. Schuller DE, Turkewitz D "Adverse effects of antihistamines." Postgrad Med 79 (1986): 75-86
  2. "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories (2002):
  3. "Product Information. Chlortrimeton (chlorpheniramine)." Schering-Plough, Liberty Corner, NJ.
  4. "Product Information. Periactin (cyproheptadine)." Merck & Company Inc (2002):
  5. "Product Information. Benadryl (diphenhydramine)." Parke-Davis (2002):
  6. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation (2001):
  7. "Product Information. Antivert (meclizine)." Roerig Division (2001):
  8. "Product Information. Optimine (azatadine)." Schering Corporation (2001):
  9. Smith SJ "Cardiovascular toxicity of antihistamines." Otolaryngol Head Neck Surg 111 Suppl (1994): 348-54
  10. "Product Information. Zyrtec (cetirizine)." Pfizer U.S. Pharmaceuticals (2001):
  11. Woosley RL "Cardiac actions of antihistamines." Annu Rev Pharmacol Toxicol 36 (1996): 233-52
  12. "Product Information. Drixoral (dextromethorphan)." Schering-Plough (2001):
  13. "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmacal Company (2001):
  14. "Product Information. Vistaril (hydroxyzine)." Pfizer U.S. Pharmaceuticals (2001):
  15. "Product Information. Dramamine (dimenhydrinate)." Pharmacia and Upjohn (2001):
View all 15 references
Moderate

Antihistamines (applies to ZzzQuil) renal/liver disease

Moderate Potential Hazard, High plausibility. Applicable conditions: Renal Dysfunction

Limited pharmacokinetic data are available for the older, first-generation antihistamines. Many appear to be primarily metabolized by the liver, and both parent drugs and metabolites are excreted in the urine. Patients with renal and/or liver disease may be at greater risk for adverse effects from antihistamines due to drug and metabolite accumulation. Therapy with antihistamines should be administered cautiously in such patients. Lower initial dosages may be appropriate.

References

  1. Glazko AJ, Dill WA, Ogilvie RI, Young RM, Smith TC "Metabolic disposition of diphenhydramine." Clin Pharmacol Ther 16 (1974): 1066-76
  2. Paton DM, Webster DR "Clinical pharmacokinetics of H1-receptor antagonists (the antihistamines)." Clin Pharmacokinet 10 (1985): 477-97
  3. Rumore MM "Clinical pharmacokinetics of chlorpheniramine." Drug Intell Clin Pharm 18 (1984): 701-7
  4. Athanikar NK, Huang SM, Sridhar K, Chiou WL, Huang YC "Pharmacokinetics of chlorpheniramine after intravenous and oral administration in normal adults." Eur J Clin Pharmacol 22 (1982): 359-65
  5. Frith EM, Simons KJ, Luciuk GH, Simons FE "Urinary excretion of chlorpheniramine and its metabolites in children." J Pharm Sci 73 (1984): 595-9
  6. Madhavan SV, Christian CD Jr, Johnson RF, Meredith CG, Schenker S "Diphenhydramine disposition in chronic liver disease." Clin Pharmacol Ther 35 (1984): 474-9
  7. Blyden GT, Shader RI, Greenblatt DJ, Scavone JM "Pharmacokinetics of diphenhydramine and a demethylated metabolite following intravenous and oral administration." J Clin Pharmacol 26 (1986): 529-33
  8. Albert KS, Hallmark MR, Sakmar E, Weidler DJ, Wagner JG "Pharmacokinetics of diphenhydramine in man." J Pharmacokinet Biopharm 3 (1975): 159-70
  9. Frith EM, Simons KJ, Simons FE "The pharmacokinetics and antihistaminic effects of brompheniramine." J Allergy Clin Immunol 70 (1982): 458-64
  10. Newman JH, Pitts JE, Turnbull LB, Bruce RB "Metabolism of brompheniramine." J Med Chem 11 (1968): 1031-4
  11. Arison BH, Porter CC, Titus DC, Gruber VF, Vandenheuvel WJ "Human metabolism of cyproheptadine." Drug Metab Dispos 3 (1975): 189-97
  12. Fischer LJ, Hintze KL, Wold JS "Disposition of cyproheptadine in rats, mice, and humans and identification of a stable epoxide metabolite." Drug Metab Dispos 3 (1975): 1-9
  13. Maddox DE, Reed CE "Clinical pharmacodynamics of antihistamines." Ann Allergy 59 (1987): 43-8
  14. Frith EM, Simons KJ, Simons FE "The pharmacokinetics and antihistaminic of the H1 receptor antagonist hydroxyzine." J Allergy Clin Immunol 73 (1984): 69-75
  15. Minuk GY, Simons KJ, Watson WT, Chen XY, Simons FE "The pharmacokinetics and pharmacodynamics of hydroxyzine in patients with primary biliary cirrhosis." J Clin Pharmacol 29 (1989): 809-15
View all 15 references
Moderate

Anxiolytics/sedatives/hypnotics (applies to ZzzQuil) glaucoma

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Glaucoma/Intraocular Hypertension, Urinary Retention

Some hypnotic drugs can have an anticholinergic effect and should be used with caution in patients with glaucoma, and trouble urinating due to retention or enlarged prostate.

References

  1. "Product Information. Benadryl (diphenhydramine)." Parke-Davis (2002):
  2. "Product Information. Unisom (doxylamine)." Pfizer U.S. Pharmaceuticals Group (2013):
Moderate

Anxiolytics/sedatives/hypnotics (applies to ZzzQuil) liver disease

Moderate Potential Hazard, Moderate plausibility.

In general, anxiolytics, sedatives and hypnotics are extensively metabolized by the liver. Their plasma clearance may be decreased and their half-life prolonged in patients with impaired hepatic function. Therapy with these drugs should be administered cautiously in patients with liver disease (some are not recommended in severe liver impairment), and the dosage should be adjusted accordingly. Laboratory testing is recommended prior and during treatment.

References

  1. "Product Information. Buspar (buspirone)." Bristol-Myers Squibb (2002):
  2. "Product Information. Placidyl (ethchlorvynol)." Abbott Pharmaceutical (2001):
  3. "Product Information. Aquachloral Supprettes (chloral hydrate)." Medisca Inc (2001):
  4. "Product Information. Equanil (meprobamate)." Wallace Laboratories (2001):
  5. "Product Information. Sonata (zaleplon)." Wyeth-Ayerst Laboratories (2001):
  6. "Product Information. Precedex (dexmedetomidine)." Abbott Pharmaceutical (2001):
  7. "Product Information. Xyrem (sodium oxybate)." Orphan Medical (2002):
  8. "Product Information. Lunesta (eszopiclone)." Sepracor Inc (2004):
  9. "Product Information. Rozerem (ramelteon)." Takeda Pharmaceuticals America (2005):
  10. "Product Information. Silenor (doxepin)." Somaxon Pharmaceuticals (2010):
  11. "Product Information. Intermezzo (zolpidem)." Purdue Pharma LP (2011):
  12. "Product Information. Hetlioz (tasimelteon)." Vanda Pharmaceuticals Inc (2014):
  13. "Product Information. Belsomra (suvorexant)." Merck & Company Inc (2014):
View all 13 references
Moderate

Anxiolytics/sedatives/hypnotics (applies to ZzzQuil) resp depression

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Asthma

Oral anxiolytic, sedative, and hypnotic agents may cause respiratory depression and apnea when given in high dosages or following acute overdose. However, some patients may be susceptible at commonly used dosages, including the elderly, debilitated or severely ill patients, those receiving other CNS depressants, and those with limited ventilatory reserve, chronic pulmonary insufficiency or other respiratory disorders. Therapy with anxiolytic, sedative, and hypnotic agents should be administered cautiously in these patients. Appropriate monitoring and individualization of dosage are recommended.

References

  1. "Product Information. Benadryl (diphenhydramine)." Parke-Davis (2002):
  2. Askenasi R, Debailleul G, Lheureux P, De Witte O "Zolpidem intoxication mimicking narcotic overdose: response to flumazenil." Hum Exp Toxicol 9 (1990): 105-7
  3. Aubier M, Murciano D, Palacios S, Parients R "Comparison of zolpidem (Z), triazolam (T), and flunitrazepam (F) effects on arterial blood gases and control of breathing in patients with severe chronic obstructive pulmonary disease (COPD)." Chest 97 Suppl (1990): s51-2
  4. "Product Information. Ambien (zolpidem)." sanofi-aventis (2001):
  5. Biban P, Filippone M, Baraldi E, Pettennazzo A, Zacchello F "Adverse effect of chloral hydrate in two young children with obstructive sleep apnea." Pediatrics 92 (1993): 461-3
  6. Faerber EN, Greenberg SB "Respiratory insufficiency following chloral hydrate sedation in two children with Leigh disease (subacute necrotizing encephalomyelopathy)." Pediatr Radiol 20 (1990): 287-8
  7. "Product Information. Placidyl (ethchlorvynol)." Abbott Pharmaceutical (2001):
  8. "Product Information. Aquachloral Supprettes (chloral hydrate)." Medisca Inc (2001):
  9. "Product Information. Equanil (meprobamate)." Wallace Laboratories (2001):
  10. "Product Information. Sonata (zaleplon)." Wyeth-Ayerst Laboratories (2001):
  11. "Product Information. Unisom (doxylamine)." Pfizer U.S. Pharmaceuticals Group (2013):
View all 11 references

ZzzQuil drug interactions

There are 413 drug interactions with ZzzQuil (diphenhydramine).

ZzzQuil alcohol/food interactions

There is 1 alcohol/food interaction with ZzzQuil (diphenhydramine).

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.