Cognitive and other adverse effects of diphenhydramine use in hospitalized older patients.
Cognitive and other adverse effects of diphenhydramine use in hospitalized older patients.
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DOI：
10.1001/archinte.161.17.2091
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发表时间：
2001-09
影响因子：
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通讯作者：
Joseph V. Agostini;L. Leo‐Summers;S. Inouye
中科院分区：
文献类型：
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作者：
Joseph V. Agostini;L. Leo‐Summers;S. Inouye
背景盐酸苯海拉明是住院患者的常用处方药，但其对老年患者的不良反应尚不清楚。方法：我们在一所大学医院招募了426名年龄在70岁及以上的住院患者进行前瞻性队列研究。测量包括基线和日常评估，包括迷你精神状态检查分数、混淆评估方法评分、医疗器械（导尿管或物理约束）的直接观察，以及使用苯海拉明的盲法医疗记录提取。结果：在426例患者中，114例（27%）在住院期间接受了苯海拉明治疗，与未接受治疗的患者相比，他们具有相似的基线特征，包括年龄、性别、谵癫风险和精神状态检查评分。苯海拉明暴露组出现任何谵妄症状（相对危险度[RR]， 1.7； 95%可信区间[CI]， 1.3-2.3）和个体谵妄症状的风险增加，包括注意力不集中（RR, 3.0; 95% CI, 1.5-5.9）、言语混乱（RR, 5.5; 95% CI, 1.0-29.8）和意识改变（RR, 3.1; 95% CI, 1.6-6.1）。暴露的患者放置导尿管的风险也增加（RR, 2.5; 95% CI, 1.0-6.0），中位住院时间更长（7天vs 6天；P = 0.009）。大多数不良结果显示出剂量-反应关系。总的来说，24%的苯海拉明剂量使用不当。结论：老年住院患者给予苯海拉明与认知能力下降及其他不良反应的风险增加相关，且呈剂量-反应关系。在这一弱势群体中，有必要仔细审查其使用情况。
BACKGROUND Diphenhydramine hydrochloride is a commonly prescribed medicine in hospitalized patients, but its adverse effects on older patients remain unclear. METHODS We enrolled 426 hospitalized medical patients aged 70 years or older in a prospective cohort study in a university hospital. Measurements included baseline and daily assessments including Mini-Mental State Examination scores, Confusion Assessment Method ratings, direct observations for medical devices (urinary catheter or physical restraints), and blinded medical record extractions for diphenhydramine use. RESULTS Of the 426 patients, 114 (27%) received diphenhydramine during hospitalization and shared similar baseline characteristics including age, sex, delirium risk, and Mini-Mental State Examination scores compared with nonexposed patients. The diphenhydramine-exposed group was at an increased risk for any delirium symptoms (relative risk [RR], 1.7; 95% confidence interval [CI], 1.3-2.3) and for individual delirium symptoms, including inattention (RR, 3.0; 95% CI, 1.5-5.9), disorganized speech (RR, 5.5; 95% CI, 1.0-29.8), and altered consciousness (RR, 3.1; 95% CI, 1.6-6.1). Exposed patients also had increased risk for urinary catheter placement (RR, 2.5; 95% CI, 1.0-6.0) and longer median length of stay (7 vs 6 days; P =.009). A dose-response relationship was demonstrated for most adverse outcomes. Overall, 24% of diphenhydramine doses were administered inappropriately. CONCLUSIONS Diphenhydramine administration in older hospitalized patients is associated with an increased risk of cognitive decline and other adverse effects with a dose-response relationship. Careful review of its use is necessary in this vulnerable population.