Debunking the Misconception: Benadryl vs. Clemastine
There has been significant interest in the potential of antihistamines for treating multiple sclerosis (MS), but it is crucial to distinguish between the different drugs being discussed. The primary confusion arises from promising research conducted on clemastine, an older, first-generation antihistamine, not Benadryl (diphenhydramine).
- In 2017, a study conducted by the University of California, San Francisco (UCSF) showed that clemastine could promote myelin repair, the protective nerve sheath damaged by MS.
- This research led to excitement about the potential for remyelination, a process that could theoretically reverse some MS damage.
- However, clemastine is not a standard, approved treatment for MS, and the doses used in clinical trials caused significant side effects, primarily fatigue.
- This research on clemastine does not apply to Benadryl, which has not demonstrated the same potential for myelin repair. Taking Benadryl over the counter to self-medicate for MS is not advised and can be harmful.
The Limited, Medical Use of Benadryl in MS
While Benadryl is not a therapy for MS itself, it does have a specific, prescribed role within MS treatment protocols. It is used as a premedication for certain intravenous (IV) infusions of disease-modifying therapies (DMTs).
Many DMTs, such as Ocrevus, Rituxan, and Tysabri, are administered via infusion. These powerful medications can sometimes cause infusion-related reactions (IRRs), which are essentially allergic reactions. To mitigate this risk, healthcare providers often administer Benadryl and other medications beforehand.
Infusion-related reaction symptoms
Infusion reactions can range from mild to severe. Symptoms can include:
- Headache
- Flushing and fever
- Chills
- Hives or itchy skin
- Facial or throat swelling
- Shortness of breath or tightness in the throat
By administering Benadryl before the infusion, doctors can help prevent or reduce the severity of these reactions, ensuring the infusion proceeds smoothly. This is the only medically recommended and supervised use of Benadryl in the context of MS treatment.
The Risks and Downsides of Taking Benadryl for MS
For general, at-home symptom management, Benadryl is not a suitable option for people with MS. Its side effects often exacerbate core MS symptoms, making it an counterproductive choice.
How Benadryl worsens MS symptoms
- Fatigue: Many people with MS already struggle with significant fatigue. Benadryl's primary side effect is drowsiness, which can worsen existing exhaustion and leave a person feeling groggy the next day.
- Cognitive Issues: MS can cause cognitive impairment, including problems with memory and concentration. Benadryl's anticholinergic properties can further impair cognitive function, which is particularly problematic for individuals already experiencing these symptoms.
- Balance and Dizziness: Dizziness and balance issues are common for MS patients. Benadryl can cause dizziness and affect coordination, increasing the risk of falls.
- Sleep Quality: While its sedative effect might help someone fall asleep, Benadryl is not conducive to high-quality, restful sleep. Experts suggest it does not aid with sleep maintenance, and better behavioral and medicinal alternatives exist for insomnia.
Comparing Benadryl (Diphenhydramine) and Clemastine for MS
| Feature | Benadryl (Diphenhydramine) | Clemastine (in trials) |
|---|---|---|
| Use in MS | Premedication for infusions to prevent allergic reactions. | Investigated for potential myelin repair, not an approved treatment. |
| Therapeutic Role | Symptomatic relief of allergy reactions associated with infusions. | Potential disease-modifying effect by stimulating oligodendrocyte differentiation. |
| Effectiveness for MS | Not effective for managing MS disease progression or common symptoms. | Early studies showed modest improvement in nerve signal transmission. |
| Common Side Effects | Significant drowsiness, fatigue, dizziness, dry mouth, and cognitive impairment. | Significant fatigue was a major side effect in clinical trials. |
| Safety for Chronic Use | Not recommended due to sedative and cognitive side effects worsening MS symptoms. | Not widely studied or approved for long-term use in MS due to side effects. |
| Status | Over-the-counter medication. | Was an OTC allergy medication but is now being studied off-label for MS. |
Safer Alternatives for MS Symptom Management
Instead of relying on Benadryl, which poses more risks than benefits for general MS symptom relief, patients should consult their healthcare provider about appropriate and safer alternatives.
- For Fatigue: Good sleep hygiene, regular exercise, and behavioral approaches are often more effective. Medications like modafinil may also be considered by a doctor.
- For Sleep Issues: Cognitive behavioral therapy, treating underlying issues like spasticity or bladder dysfunction, and specific prescription medications can provide more restful sleep than Benadryl.
- For Dizziness: Management can involve physical therapy to improve balance or targeted medications for vertigo, depending on the cause.
- For Infusion Reactions: While Benadryl is standard premedication, your healthcare team can discuss other antihistamines, such as cetirizine, which may have fewer fatiguing effects.
Conclusion: A Clear Distinction is Key
The notion of why Benadryl is great for multiple sclerosis is a dangerous oversimplification rooted in the confusion between different antihistamines. While another drug, clemastine, is being researched for its potential to repair myelin damage, Benadryl (diphenhydramine) offers no such benefit. Instead, its well-known side effects, particularly fatigue and cognitive impairment, can exacerbate some of the most challenging symptoms of MS, making it an unsuitable and often detrimental choice for general symptom management. Its only valid use is as a pre-infusion medication administered under strict clinical supervision. Patients with MS should always consult their neurologist or care team before taking any over-the-counter medication to ensure it doesn't negatively impact their condition or interact with existing treatments.
Summary of Key Differences
Benadryl's Role: Not a Treatment, But a Pre-Medication
Benadryl is not a therapy for MS, but is medically administered before certain infusions to prevent allergic reactions, not to treat the disease itself.
Side Effects Outweigh Benefits
For general use, Benadryl's sedative and cognitive side effects, such as drowsiness and impaired memory, can worsen common MS symptoms like fatigue and brain fog.
Potential for Worse Sleep
While Benadryl can cause sleepiness, it does not promote restful sleep and is not recommended as a sleep aid for MS patients, who often have complex sleep issues.
Clemastine is Not Benadryl
Promising research into remyelination involved clemastine, a different antihistamine, which should not be confused with Benadryl (diphenhydramine).
Physician Consultation is Crucial
Patients should never self-medicate with over-the-counter drugs for MS symptoms without first consulting their healthcare provider.
Safer Alternatives Exist
For managing fatigue, sleep issues, and dizziness, there are more effective and safer alternatives than Benadryl, which can be discussed with a medical professional.
FAQs
Q: Is it ever safe for someone with MS to take Benadryl?
A: Yes, it is safe when administered by a healthcare professional as a premedication before an MS infusion treatment, such as Ocrevus or Tysabri, to prevent an allergic reaction. It is not safe for regular, at-home use for general symptom management.
Q: Can I take Benadryl for my MS-related insomnia?
A: No, Benadryl is not recommended as a sleep aid for people with MS. While it causes drowsiness, it doesn't promote restful sleep and can worsen MS-related fatigue and cognitive issues the following day. Better alternatives exist and should be discussed with a doctor.
Q: Why do doctors give Benadryl before an infusion treatment?
A: Doctors give Benadryl as a premedication to minimize the risk and severity of allergic or infusion-related reactions that can occur with some MS medications.
Q: I heard an antihistamine could repair myelin. Is that Benadryl?
A: No, the research that generated excitement about myelin repair was focused on a different antihistamine called clemastine, not Benadryl (diphenhydramine). Research on clemastine is still in the experimental phase and is not a standard treatment.
Q: What are the main risks of taking Benadryl if you have MS?
A: The main risks include increased fatigue, cognitive impairment (brain fog, memory issues), and dizziness, all of which are common MS symptoms that Benadryl's side effects can worsen.
Q: What should I use instead of Benadryl for managing fatigue?
A: For managing MS-related fatigue, safer and more effective strategies include practicing good sleep hygiene, exercising regularly, and exploring cognitive behavioral therapy. Your doctor may also suggest other medications specifically for fatigue.
Q: Are there non-drowsy antihistamines that are safer for MS patients?
A: Yes. Unlike Benadryl, which has sedative effects, non-drowsy antihistamines like fexofenadine (Allegra) or loratadine (Claritin) do not typically cause drowsiness and are preferable for managing allergies without exacerbating fatigue or cognitive symptoms. However, you should still consult your doctor before taking any new medication.
Q: Should I stop taking Benadryl if I was using it for another condition?
A: If you have MS and were using Benadryl for something else, like allergies or sleep, you should speak with your neurologist or care team. They can help you find a safer alternative that doesn't worsen your MS symptoms.
Q: Could I have a negative reaction to Benadryl during an infusion?
A: While premedication is designed to prevent reactions, it is still possible to have a side effect, such as feeling excessively tired. Inform your healthcare team about any unpleasant effects so they can adjust your care plan if needed.
Q: How do I know if Benadryl is causing my fatigue to worsen?
A: Pay attention to how you feel after taking Benadryl. If you notice increased drowsiness, dizziness, or confusion, especially on the day after, it's likely worsening your fatigue. Talk to your doctor about these observations.
