People’s Pharmacy: Can sleeping pills wake some people up?
Q. Any product like a nighttime pain reliever that contains the antihistamine diphenhydramine (DPH) has the opposite effect on me, keeping me awake all night with jitters and restless-leg type symptoms. This is the opposite of what one would expect or want.
As a result, I have to be very careful about what I take when I can’t sleep. I would really like to understand why I have this reaction to DPH products. Also, what can I take when I need help with sleep?
A. You are describing “paradoxical excitation on diphenhydramine.” This antihistamine is found in the allergy drug Benadryl. Most people find that this medication makes them drowsy. That is why it is included in so many nighttime pain relievers such as Advil PM, Aleve PM and Tylenol PM.
Pharmacologists have known for decades that some people react differently to DPH. Instead of becoming drowsy, they may become agitated or anxious. One hypothesis is that these individuals metabolize DPH very rapidly to a stimulant compound (CNS Spectrums, February 2008). We wish the Food and Drug Administration required some information about this reaction on the “PM” pain reliever packaging.
You may find some natural sleep aids less disruptive. Valerian, passionflower, tart cherry juice, lemon balm or melatonin are popular and can sometimes be helpful. To learn more about these approaches and other strategies, you may find our “eGuide to Getting a Good Night’s Sleep” helpful. This online resource can be found under the Health eGuides tab at www.PeoplesPharmacy.com.
Q. I’ve been taking the antidepressant bupropion for some time, and I’ve had multiple side effects. The worst was seizures caused by the medication. I fell on the ground, hit my head and lost consciousness.
My wife called 911, and I was taken to the emergency room. That’s where they concluded the seizures were caused by bupropion. Do I have any recourse?
A. During the early testing of the brand name antidepressant Wellbutrin (bupropion), some people suffered seizures. That delayed marketing for several years.
There is a seizure warning in the official prescribing information, which could make it challenging to find a lawyer who would be willing to take such a case. Your physician should have warned you about this potential risk.
Q. I recently was prescribed a medication and filled it at the local branch of a large pharmacy chain. The prescription ran out, as it was supposed to. The pharmacy has texted four times asking if I want to refill it. I have replied four times with “NO.”
Why would they keep pushing to refill it? The prescription has no refills, yet they offer to contact my doctor about a refill. Wouldn’t one “NO” be enough? Do they get some kind of kickback for doing this?
A. Some large pharmacy chains are very aggressive about promoting prescription refills. It is not about a kickback, exactly, but there is a financial incentive to sell as many pills as possible. Some of the messages you’ve been seeing might be automated. That could explain why they haven’t taken “NO” for an answer.
Generally speaking, if the doctor wanted you to keep on taking the medication, he or she would have put a specific number of refills on the prescription. Patients need to be vigilant, so they don’t end up taking too many medicines for too long.
In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”