Summary
Several poisonings by diphenhydramine were reported shortly after it had been introduced as an antihistamine in 1945. In the Federal Republic of Germany its combination with 8-chlorotheophylline (dimenhydrinate) is available as a hypnotic without prescription. Replacing the dangerous diethylpentenamide diphenhydramine is a drug which is also often abused.
Fatal poisonings, suicide attempts, and traffic accidents were increasingly observed. In seven cases drug-influenced road users caused traffic accidents. We observed blood concentrations of diphenhydramine as high as in four cases of clinically treated patients after ingestion of large doses. This indicates a serious drug abuse.
The measurement of the concentration of diphenhydramine and its major metabolite (diphenmethoxy acetic acid) in blood and urine is a means of recognizing chronic use and misuse of diphenhydramine. As the metabolite accumulates in blood one may find an elevated level after multiple dosing. Shortly after taking a single dose no or only low metabolite concentration is found. The concentration of diphenhydramine and its metabolite was measured in several fatal cases. In one of these cases the concentration in body fluids and tissues was in a range not observed until now.
Zusammenfassung
Kurz nach der Einführung des Wirkstoffes (1945) konnten Vergiftungen mit Diphenhydramin beobachtet werden. Seit Diphenhydramin, zusammen mit 8-Chlortheophyllin als Dimenhydrinat im Handel, anstelle des gefährlicheren Diethylpentenamid als rezeptfreies Schlafmittel angeboten wird, stiegen auch die Zahlen von Vergiftungen und Verkehrsunfällen unter Diphenhydramin-Einfluß. Der Vergleich von vier klinisch behandelten und überlebenden Patienten mit sieben unter Diphenhydramin-Einfluß verunfallten Verkehrsteilnehmern zeigt, daß hier massive Intoxikationen bei erheblichem Tablettenmißbrauch vorgelegen haben. Aus den Verhältnissen der Diphenhydramin-Konzentration in Blut und Urin sowie den Konzentrationen der als Hauptstoffwechselprodukt entstehenden Diphenmethoxyessigsäure lassen sich wertvolle Hinweise auf chronischen Mißbrauch bzw. den Aufnahmezeitpunkt der Tabletten gewinnen. Bei verschiedenen tödlichen Vergiftungen wurde unter anderem eine massive Vergiftung vorgefunden, die zu bisher noch nicht beschriebenen hohen Konzentrationen von Diphenhydramin in Körperflüssigkeiten und Geweben geführt hat.
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Poster-Demonstration auf der 59. Tagung der Deutschen Gesellschaft für Rechtsmedizin, Heidelberg, September 1980
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Aderjan, R., Bösche, J. & Schmidt, G. Vergiftungen mit Diphenhydramin — Forensisch-toxikologische Beurteilung von Analysenbefunden. Z Rechtsmed 88, 263–270 (1982). https://doi.org/10.1007/BF00198661
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DOI: https://doi.org/10.1007/BF00198661