Acefylline Piperazine/Diphenhydramine

Cardiac/bronchial asthma, pulmonary emphysema, chronic bronchitis.

Diphenhydramine in the injectable form is effective in adults and pediatric patients, other than premature infants and neonates, for the following conditions when Diphenhydramine in the oral form is impractical.

Antihistaminic

For amelioration of allergic reactions to blood or plasma, in anaphylaxis as an adjunct to epinephrine and other standard measures after the acute symptoms have been controlled, and for other uncomplicated allergic conditions of the immediate type when oral therapy is impossible or contraindicated.

Motion sickness

For active treatment of motion sickness.

Antiparkinsonism

For use in parkinsonism, when oral therapy is impossible or contraindicated, as follows: parkinsonism in the elderly who are unable to tolerate more potent agents; mild cases of parkinsonism in other age groups, and in other cases of parkinsonism in combination with centrally acting anticholinergic agents.

Diphenhydramine is an antihistamine. Diphenhydramine blocks the effects of the naturally occurring chemical histamine in the body.

Diphenhydramine is used to treat sneezing; runny nose; itching, watery eyes; hives; rashes; itching; and other symptoms of allergies and the common cold.

Diphenhydramine is also used to suppress coughs, to treat motion sickness, to induce sleep, and to treat mild forms of Parkinson's disease.

Diphenhydramine may also be used for purposes other than those listed in this medication guide.

Tab 2-8 tab daily in divided doses. Amp 3-4 amp daily IM or 1-2 amp daily IV.

Usual Adult Dose for Insomnia

Note: Acetaminophen-diphenhydramine is generally dosed based on the diphenhydramine component to equal 50 mg of diphenhydramine (76 mg diphenhydramine citrate) at bedtime.

Acetaminophen-diphenhydramine comes in several different dosages (500 mg-25 mg, 650 mg-50 mg, 500 mg-38 mg, 500 mg-12.5 mg, 1000 mg-50 mg, 500 mg-50 mg, 325 mg-12.5 mg) and is available as liquid, caplets, geltabs, and gelcaps. The manufacturer of these products generally advises 2 dosage units at bedtime or as directed by a healthcare professional.

Usual Adult Dose for Pain

Note: Acetaminophen-diphenhydramine is generally dosed based on the diphenhydramine component to equal 50 mg of diphenhydramine (76 mg diphenhydramine citrate) at bedtime.

Acetaminophen-diphenhydramine comes in several different dosages (500 mg-25 mg, 650 mg-50 mg, 500 mg-38 mg, 500 mg-12.5 mg, 1000 mg-50 mg, 500 mg-50 mg, 325 mg-12.5 mg) and is available as liquid, caplets, geltabs, and gelcaps. The manufacturer of these products generally advises 2 dosage units at bedtime or as directed by a healthcare professional.

Usual Adult Dose for Headache

Note: Acetaminophen-diphenhydramine is generally dosed based on the diphenhydramine component to equal 50 mg of diphenhydramine (76 mg diphenhydramine citrate) at bedtime.

Acetaminophen-diphenhydramine comes in several different dosages (500 mg-25 mg, 650 mg-50 mg, 500 mg-38 mg, 500 mg-12.5 mg, 1000 mg-50 mg, 500 mg-50 mg, 325 mg-12.5 mg) and is available as liquid, caplets, geltabs, and gelcaps. The manufacturer of these products generally advises 2 dosage units at bedtime or as directed by a healthcare professional.

Usual Pediatric Dose for Insomnia

Greater than or equal to 12 years:

Note: Acetaminophen-diphenhydramine is generally dosed based on the diphenhydramine component to equal 50 mg of diphenhydramine (76 mg diphenhydramine citrate) at bedtime.

Acetaminophen-diphenhydramine comes in several different dosages (500 mg-25 mg, 650 mg-50 mg, 500 mg-38 mg, 500 mg-12.5 mg, 1000 mg-50 mg, 500 mg-50 mg, 325 mg-12.5 mg) and is available as liquid, caplets, geltabs, and gelcaps. The manufacturer of these products generally advises 2 dosage units at bedtime or as directed by a healthcare professional.

Usual Pediatric Dose for Pain

Greater than or equal to 12 years:

Note: Acetaminophen-diphenhydramine is generally dosed based on the diphenhydramine component to equal 50 mg of diphenhydramine (76 mg diphenhydramine citrate) at bedtime.

Acetaminophen-diphenhydramine comes in several different dosages (500 mg-25 mg, 650 mg-50 mg, 500 mg-38 mg, 500 mg-12.5 mg, 1000 mg-50 mg, 500 mg-50 mg, 325 mg-12.5 mg) and is available as liquid, caplets, geltabs, and gelcaps. The manufacturer of these products generally advises 2 dosage units at bedtime or as directed by a healthcare professional.

Usual Pediatric Dose for Headache

Greater than or equal to 12 years:

Note: Acetaminophen-diphenhydramine is generally dosed based on the diphenhydramine component to equal 50 mg of diphenhydramine (76 mg diphenhydramine citrate) at bedtime.

Acetaminophen-diphenhydramine comes in several different dosages (500 mg-25 mg, 650 mg-50 mg, 500 mg-38 mg, 500 mg-12.5 mg, 1000 mg-50 mg, 500 mg-50 mg, 325 mg-12.5 mg) and is available as liquid, caplets, geltabs, and gelcaps. The manufacturer of these products generally advises 2 dosage units at bedtime or as directed by a healthcare professional.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Use with caution in patients with liver disease. Chronic use of acetaminophen is not recommended in patients with liver disease.

Precautions

Patients who consume three or more alcohol containing drinks per day should be informed to consult with their physician for advice on when and how to take acetaminophen. Chronic, heavy alcohol users may be at increased risk of liver damage when taking more than recommended dosages.

Patients and adults taking care of children should be advised to consult with their doctor before continuing to use acetaminophen if symptoms of illness worsen. Although rare, there is the possibility of acetaminophen intoxication on chronic use of the drug, and the symptoms seen during the first phase of intoxication (nausea, vomiting, anorexia, malaise, and diaphoresis) may trigger the use of more doses.

Patients should be warned of the sedative effects of diphenhydramine, and advised not to take this drug with alcohol.

Due to the anticholinergic effect of diphenhydramine, it should be used with caution in patients with narrow-angle glaucoma, stenosing peptic ulcer, pyloroduodenal obstruction, prostatic hypertrophy or bladder neck obstructions. It should also be used with caution in patients with increased intraocular pressure, hyperthyroidism, cardiovascular disease, or hypertension.

Dialysis

Data not available

Cardiac failure,cardiac arrythmias,hypertension,hyperthyroidism,gastric ulcer,hepatic failure,chronic alcoholism, epilepsy.

See also:
What is the most important information I should know about Diphenhydramine?

Hypersensitivity to diphenhydramine, other structurally related antihistamines, or any component of the formulation; neonates or premature infants; breast-feeding

Additional contraindications:

Parenteral: Use as a local anesthetic

OTC labeling: When used for self-medication, do not use in children <6 years, to make a child sleep, or with any other diphenhydramine-containing products (including topical products)

Use Diphenhydramine as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Take Diphenhydramine by mouth with or without food.
• Do not remove the strip from the pouch until you are ready to take Diphenhydramine. Make sure that your hands are dry when you open Diphenhydramine. Remove and place the strip on the tongue. The strip dissolves quickly (and it can be swallowed with saliva). Diphenhydramine may be taken with or without water. Take the strip immediately after opening the pouch. Do not store the strip for future use.
• Use Diphenhydramine exactly as directed on the package, unless instructed differently by your doctor. If you are taking Diphenhydramine without a prescription, follow any warnings and precautions on the label.
• If you miss a dose of Diphenhydramine and you are taking it regularly, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Diphenhydramine.

Diphenhydramine is an antihistamine used to relieve symptoms of allergy, hay fever, and the common cold. These symptoms include rash, itching, watery eyes, itchy eyes/nose/throat, cough, runny nose, and sneezing. It is also used to prevent and treat nausea, vomiting and dizziness caused by motion sickness. Diphenhydramine can also be used to help you relax and fall asleep.

This medication works by blocking a certain natural substance (histamine) that your body makes during an allergic reaction. Its drying effects on such symptoms as watery eyes and runny nose are caused by blocking another natural substance made by your body (acetylcholine).

Cough-and-cold products have not been shown to be safe or effective in children younger than 6 years. Therefore, do not use this product to treat cold symptoms in children younger than 6 years unless specifically directed by the doctor. Some products (such as long-acting tablets/capsules) are not recommended for use in children younger than 12 years. Ask your doctor or pharmacist for more details about using your product safely.

These products do not cure or shorten the length of the common cold and may cause serious side effects. To decrease the risk for serious side effects, carefully follow all dosage directions. Do not use this product to make a child sleepy. Do not give other cough-and-cold medication that might contain the same or similar ingredients. Ask the doctor or pharmacist about other ways to relieve cough and cold symptoms (such as drinking enough fluids, using a humidifier or saline nose drops/spray).

OTHER USES: This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.

Diphenhydramine is also used alone or with other medications to treat shaking (tremor) and muscle stiffness caused by Parkinson's disease. It may also be used to treat side effects of certain psychiatric drugs such as involuntary movements and muscle stiffness (such as EPS). It works by blocking acetylcholine.

How to use Diphenhydramine

Follow all directions on the product package. If your doctor has prescribed this medication, take it as directed. If you are uncertain about any of the information, consult your doctor or pharmacist.

Take the tablet, capsule, or liquid form by mouth with or without food. Measure liquid forms of this medication using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose. If you have a single-dose form of this medication (such as a single-use whistle), you do not need to measure the dose.

The rapidly-dissolving tablet or strip should be allowed to dissolve on the tongue and then swallowed, with or without water. The chewable tablets should be chewed thoroughly before being swallowed.

The dosage is based on your age, medical condition, and response to treatment. There are many brands and forms of diphenhydramine available. Read the dosing instructions carefully for each product because the amount of diphenhydramine may be different between products. Do not increase your dose or take this medication more often than directed.

To prevent motion sickness, take your dose 30 minutes before starting activity such as travel. To help you sleep, take your dose about 30 minutes before bedtime. If you continue to have difficulty sleeping for longer than 2 weeks, contact your doctor.

Tell your doctor if your condition does not improve or if it worsens.

Acefylline Piperazine requires a reduction of dose if coadministered with drugs that may reduce its clearance e.g. allopurinol, contraceptive pills, cimetidine, macrolides, quinolones or propranolol.

Acefylline Piperazine requires an increase of dose if coadministered with drugs that may increase its clearance e.g. phenytoin, rifampicin, ritonavir and sulphinpyrazone.

See also:
What other drugs will affect Diphenhydramine?

Most reports of clinically significant drug interactions occurring with the barbiturates have involved phenobarbital

1. Anticoagulants: Diphenhydramine lowers the plasma levels of dicumarol (name previously used: bishydorxycoumarin) and causes a decrease in anticoagulant activity as measured by the prothrombin time. Diphenhydramine can induce hepatic microsomal enzymes resulting in increased metabolism and decreased anticoagulant response of oral anticoagulants (e.g., warfarin, acenocournarol, dicumarol, and phenprocoumon). Patients stabilized on anticoagulant therapy may require dosage adjustments if phenobarbital is added to or withdrawn from their dosage regimen

2. Corticosteroids: Diphenhydramine appears to enhance the metabolism of exogenous corticosteroids probably through the induction of hepatic microsomal enzymes. Patients stabilized on corticosteroid therapy may require dosage adjustments if phenobarbital is added to or withdrawn from their dosage regimen.

3. Griseofulvin: Diphenhydramine appears to interfere with the absorption of orally administered griseofulvin, thus decreasing its blood level. The effect of the resultant decreased blood levels of griseofulvin on therapeutic response has not been established. However, it would be preferable to avoid concomitant administration of these drugs.

4. Doxycycline: Diphenhydramine has been shown to shorten the half- life of doxycycline for as long as 2 weeks after barbiturate therapy is discontinued. This mechanism is probably through the induction of hepatic microsomal enzymes that metabolize the antibiotic. If phenobarbital and doxycycline are administered concurrently, the clinical response to doxycycline should be monitored closely

5. Phenytoin, sodium valproate, valproic acid: The effect of phenobarbital on the metabolism of phenytoin appears to be variable. Some investigators report an accelerating effect, while others report no effect. Because the effect of phenobarbital on the metabolism of phenytoin is not predictable, phenytoin and phenobarbital blood levels should be monitored more frequently if these drugs are given concurrently. Sodium valproate and valproic acid appear to decrease phenobarbital metabolism; therefore, phenobarbital blood levels should be monitored and appropriate dosage adjustments made as indicated.

6. Central nervous system depressants: The concomitant use of other central nervous system depressants including other sedatives or hypnotics, antihistamines, tranquilizers, or alcohol, may produce additive depressant effects

7. Monoamine oxidase inhibitors (MAOIs): MAOIs prolong the effects of phenobarbital probably because metabolism of the phenobarbital is inhibited.

8. Estradiol, estrone, progesterone and other steroidal hormones: Pretreatment with or concurrent administration of phenobarbital may decrease the effect of estradiol by increasing its metabolism. There have been reports of patients treated with antiepileptic drugs (e.g., phenobarbital) who became pregnant while taking oral contraceptives. An alternate contraceptive method might be suggested to women taking phenobarbital.

Nausea, vomiting, abdominal pain, diarrhoea, headache, tremors or palpitations may sometimes occur.

See also:
What are the possible side effects of Diphenhydramine?

Applies to acetaminophen / diphenhydramine: tablets

Other dosage forms:

• capsules, tablets

Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Constipation; diarrhea; dizziness; drowsiness; dry mouth, nose, or throat; excitability; headache; loss of appetite; nausea; nervousness or anxiety; upset stomach; vomiting; weakness.

Seek medical attention right away if any of these SEVERE side effects occur while taking acetaminophen / diphenhydramine:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); dark urine or pale stools; difficulty urinating or inability to urinate; fast or irregular heartbeat; hallucinations; seizures; severe dizziness, drowsiness, lightheadedness, or headache; severe or persistent loss of appetite; stomach pain; tremor; trouble sleeping; unusual fatigue; vision changes; yellowing of the skin or eyes.

Diphenhydramine is used to treat hypertension and edema. Like other thiazides, benzthiazide promotes water loss from the body (diuretics). They inhibit Na+/Cl- reabsorption from the distal convoluted tubules in the kidneys. Thiazides also cause loss of potassium and an increase in serum uric acid. Thiazides are often used to treat hypertension, but their hypotensive effects are not necessarily due to their diuretic activity. Thiazides have been shown to prevent hypertension-related morbidity and mortality although the mechanism is not fully understood. Thiazides cause vasodilation by activating calcium-activated potassium channels (large conductance) in vascular smooth muscles and inhibiting various carbonic anhydrases in vascular tissue.