Diphenhydramine dependence through deep intramuscular injection resulting in myonecrosis and prolonged QT interval.

Abstract

WHAT IS KNOWN AND OBJECTIVE:

Diphenhydramine (DPH) is a first-generation antihistamine, which is useful in treating allergic reaction, and is usually considered innocuous. We describe a retired nurse with history of depression, who began to develop drug-seeking behaviour after her first receiving of an intramuscular (IM) DPH injection due to urticaria.

CASE SUMMARY:

The 49-year-old patient had developed IM DPH dependence within 4 months. She needed to receive psychiatric inpatient treatment because of depressive mood, serious myonecrosis over injected sites, and prolongation of QT interval.

WHAT IS NEW AND CONCLUSION:

This is the first reported case of DPH dependence through the IM route. Second-generation antihistamines might be better choices for patients with psychiatric illness by reason of their lower effects on central nervous system and lower risk of abuse.

• Authors: T-Y Chen, Y-W Yeh, S-C Kuo, C-Y Chen, T-P Lin, C-C Chang
• Journal: Journal of clinical pharmacy and therapeutics (J Clin Pharm Ther) Vol. 39 Issue 3 Pg. 325-7 (Jun 2014) ISSN: 1365-2710 [Electronic] England
• PMID: 24597640 (Publication Type: Case Reports, Journal Article)
• Copyright: © 2014 John Wiley & Sons Ltd.

Chemical References

• Histamine H1 Antagonists
• Diphenhydramine

Topics

• Arrhythmias, Cardiac (chemically induced)
• Brugada Syndrome
• Cardiac Conduction System Disease
• Depression (epidemiology)
• Diphenhydramine (administration & dosage, adverse effects)
• Drug-Seeking Behavior
• Female
• Heart Conduction System (abnormalities)
• Histamine H1 Antagonists (administration & dosage, adverse effects)
• Humans
• Injections, Intramuscular
• Middle Aged
• Muscles (pathology)
• Necrosis
• Substance-Related Disorders (epidemiology)