[HN Gopher] Effects of fexofenadine, diphenhydramine, and alcoho...
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       Effects of fexofenadine, diphenhydramine, and alcohol on driving
       performance
        
       Author : jasonhansel
       Score  : 25 points
       Date   : 2022-04-30 19:58 UTC (3 hours ago)
        
 (HTM) web link (pubmed.ncbi.nlm.nih.gov)
 (TXT) w3m dump (pubmed.ncbi.nlm.nih.gov)
        
       | etaioinshrdlu wrote:
       | 50mg diphenhydramine is quite a bit! Anyone who has ever taken
       | that amount for sleep effects will tell you so.
        
         | retrac wrote:
         | It is, but 25 - 50 mg every 4 - 6 hours, with no more than 200
         | mg over 24 hours, is also the instructions on the OTC bottle I
         | have.
         | 
         | I made that mistake once in university. Took two capsules for a
         | moderate skin reaction and slept the entire afternoon away.
         | Fortunately I was at home! Just willing myself to get up long
         | enough to disrobe and turn the lights off was excruciating.
        
       | hammock wrote:
       | To play devil's advocate:
       | 
       | People forget that drunk driving laws started as the result of
       | activist campaigns from special interest groups only a few
       | decades ago.
       | 
       | It is itself a victimless crime; we have existing laws against
       | reckless driving, causing accidents, vehicular manslaughter,
       | etc.; and as this study shows there are plenty of common, less
       | regulated (i.e. showing no signs of impairment yet blowing into a
       | measurement device cannot get you nailed) driving conditions
       | which are as bad or worse than drunk driving.
        
         | ipsin wrote:
         | It seems like a "victimless crime" in the same way that a hit
         | and run is a victimless crime, as long as you get away with it.
         | 
         | Someone has willfully chosen to make life more dangerous for
         | everyone else. It's possible they won't be caught, but ignoring
         | the act carries a real possibility of harm.
         | 
         | There are people who would drive drunk every single day, if
         | they could get away with it.
        
           | hammock wrote:
           | > hit and run is a victimless crime
           | 
           | Not clear on your logic. A hit and run has a victim: whoever
           | is the owner of the person or property you damaged.
           | 
           | In contrast, a drunk driver who is not under excess influence
           | of the alcohol in his system and who gets from point A to
           | point B safely, has victimized no one.
        
             | jjulius wrote:
             | >In contrast, drunk driver who is not under excess
             | influence of the alcohol in his system and who gets from
             | point A to point B safely, has created no victims.
             | 
             | And what of the drunk driver under excess influence who
             | creates a victim?
        
               | nyolfen wrote:
               | presumably he is still subject to the laws that relate to
               | creating a victim
        
           | weaksauce wrote:
           | The founder of madd in america thinks they went too far
           | though.
           | 
           | https://www.washingtontimes.com/news/2002/aug/6/20020806-035.
           | ..
           | 
           | > Candy Lightner, MADD's founder, says she disassociated
           | herself from the movement in 1985 because she believed the
           | organization was headed in the wrong direction.
           | 
           | > "It has become far more neo-prohibitionist than I had ever
           | wanted or envisioned," said Mrs. Lightner, who founded MADD
           | after her daughter was killed by a drunk driver. "I didn't
           | start MADD to deal with alcohol. I started MADD to deal with
           | the issue of drunk driving."
           | 
           | > Several years after she left MADD, Mrs. Lightner briefly
           | represented the American Beverage Institute in its fight
           | against the 0.08 percent BAC law. She also lobbied Congress
           | to enforce tougher penalties for drunk drivers.
           | 
           | Maybe she took up that position after getting hired by the
           | beverage industry or not I don't know but she did lose a
           | child to a drunk driver. 0.08 is probably too strict as the
           | consequences of that are really severe and as evidenced
           | basically no more impairing than widely used daily
           | antihistamines.
        
             | sokoloff wrote:
             | I would sooner drive after a couple beers with dinner than
             | after taking Benadryl (diphenhydramine). That's not because
             | I think alcohol is safe to drive on.
        
         | 0xB31B1B wrote:
         | Shooting a gun into a crowd and not hitting anyone is also a
         | "victimless crime", that doesn't mean it isn't high risk
         | behavior that should be discouraged. The reality is that the
         | large majority of drunk drivers are chronic drunks and drunk
         | driving rules are pretty effective at taking them off the road.
        
           | hammock wrote:
           | >the large majority of drunk drivers are chronic drunks and
           | drunk driving rules are pretty effective at taking them off
           | the road.
           | 
           | That's a good point. Aren't you now arguing though that the
           | vast majority of drinkers, who are not chronic drunks, be
           | punished for the actions of a few?
        
             | tom_ wrote:
             | The vast majority of drinkers, and this includes many of
             | the chronic drunks, aren't being punished at all by these
             | rules! Because they don't drive after drinking.
        
         | rngoea wrote:
        
         | mikotodomo wrote:
         | WTF, it's not a victimless crime. You have a much higher chance
         | of getting in an accident and killing someone when you're
         | drunk. Someone dies every 50 minutes in America from drunk
         | driving accidents.
        
       | weberer wrote:
       | I can't imagine trying to drive for an hour after taking
       | diphenhydramine. It usually knocks me out hard within 20 minutes.
        
       | [deleted]
        
       | Trouble_007 wrote:
       | FYI: Antihistamines :
       | https://psychonautwiki.org/wiki/Antihistamine
       | 
       | Diphenhydramine : https://psychonautwiki.org/wiki/Diphenhydramine
        
       | tyrfing wrote:
       | 2nd gen antihistamines (Fexofenadine, Cetirizine, Loratidine) are
       | definitely what you want for allergies. 1st gen like
       | Benadryl/Diphenydramine have awful side effects. I highly
       | recommend nasal sprays like Fluticasone as well, available OTC in
       | the US these days and amazing stuff.
        
         | iancmceachern wrote:
         | Fluticasone changed my life. It's a wonder drug.
        
         | amluto wrote:
         | I would argue that, whatever "generation" it is, cetirizine
         | does not deserve credit for being second generation. I know
         | plenty of people with extremely obvious CNS effects from it. In
         | contrast, loratadine seems innocuous.
        
           | _moof wrote:
           | Cetirizine is a "no go" for pilots. Fexofenadine and
           | loratadine are OK to fly on though, as is fluticasone.
        
           | isoprophlex wrote:
           | Second that, cetirizine definitely feels more like clemastine
           | or meclizine than a proper second gen "non sedating"
           | antihistamine. And with hay fever AND an allergy to nuts,
           | I've tried them all, haha.
        
           | tyrfing wrote:
           | For me, loratadine was ineffective, and I can't distinguish
           | cetirizine and fexofenadine - both are maybe 50-60% effective
           | with no notable side effects, and allergy season means extra
           | fatigue no matter what. Cetirizine does have the shortest
           | half life.
        
           | imdvayn wrote:
           | Unfortunately its justifiably classified as 2nd gen and IIRC
           | studies show that it's generally more effective for hay
           | fever. Personally, I've found that loratadine is pretty
           | ineffective, especially after regular use.
        
             | jostmey wrote:
             | I found loratadine very effective but it takes time to
             | work. At least a week
        
         | imdvayn wrote:
         | +1 to Fexofenadine (Allegra) and Fluticasone. Loratadine
         | (Claritin) is too weak for my needs and Cetrazine (Zyrtec) has
         | side effects are too similar to a stimulant for me.
        
         | sjmm1989 wrote:
         | Ironically, whilst having terrible hayfever... Not taking
         | Antihistamines at all seems to have had the most profound
         | effect on me between the gen 1 and 2 meds. If I didn't know any
         | better, I would almost figure I was having some sort of rebound
         | effect from taking them in the first place. Which is odd,
         | because I have been diagnosed with having Allergic Sinusitis,
         | which triggers an inflammatory asthma if not careful.
         | 
         | I used 1st gen stuff like Chlorpheniramine and Diphenhydramine
         | to start. Tried some second gen stuff not too long ago, and it
         | worked pretty well too; but not as well just not taking any?
         | It's weird. Meanwhile if I have an actual allergy attack, I
         | keep Benadryl around for just in case. Because again, not
         | taking any of these seems to just leave me without any
         | allergies now? Or as bad at least. But Benadryl seems to still
         | have some effect, where as I need a couple days of taking the
         | 2nd gen stuff to actually get any effect; if any at all.
         | 
         | All in all, I'm confused now as to which I should even take
         | considering everything in how my reactions have been to it all.
         | So I just don't take any unless things are real bad now. Which
         | they usually aren't.
         | 
         | Maybe I outgrew my allergies? I doubt it, cause I still sneeze
         | around cats and stuff. heh.
        
         | rhexs wrote:
         | These are great. Europe has some even newer 2nd (or "3rd gen")
         | antihistamines such as bilastine and rupatadine. They're
         | apparently even more effective than what we have in the states.
         | 
         | Would love to try them out, but unfortunately I don't think
         | they're seeking FDA approval. Anyone abroad have any experience
         | with these compared to loratadine/cetirizine?
        
         | hammock wrote:
         | > Fluticasone
         | 
         | A corticosteroid, it has awful side effects as well
        
           | dfsegoat wrote:
           | Maybe. But I would say for me the benefits of not suffering
           | "breakthrough" hayfever attacks far outweigh the side
           | effects.
           | 
           | Antihistamines are great - but the nasal corticosteroids are
           | what really control my hayfever (1) when used consistently.
           | 
           | 1 - Hayfever so bad that I used to have to get custom serum
           | shots containing the local pollen profile, every 2 weeks as a
           | kid. Had anaphylaxis twice.
        
             | [deleted]
        
       | mberning wrote:
       | I didn't see it in the abstract but how are the alcohol and
       | placebo administered? If they were ingested the participant
       | surely knew they got alcohol or a placebo. And I assume that may
       | have some impact on their performance aside from possibly being
       | intoxicated. I suppose all 4 could be IV administered, but it
       | doesn't sound like that.
        
         | 988747 wrote:
         | Well, you can give non-alcoholic beer to the subject telling
         | them it is a real thing. Or make them a cocktail, such as
         | Mojito, just a virgin one. Or the opposite: give them a soda
         | secretly spiced with vodka. The possibilities are endless. But
         | the problem is: people usually are familiar with how being
         | drunk feels (and 0.1% BAC is pretty drunk), so it's almost
         | impossible to hide the fact from them. So I guess "placebo
         | group" is only with relation to drugs, not to alcohol.
        
       | omarhaneef wrote:
       | This is the context I was missing (brand names)
       | 
       | https://www.drugs.com/ingredient/diphenhydramine.html
        
         | jmalicki wrote:
         | Yes, it's marketed as ZzzQuil an OTC sleeping aid! (as well as
         | benadryl)
        
       | stordoff wrote:
       | Is 60mg a typical dose of fexofenadine? I'm only familiar with it
       | as 180mg tablets (I was initially prescribed 180mg twice daily
       | for dermatographic urticaria, and currently take 360mg twice
       | daily).
        
         | volkl48 wrote:
         | 60mg is the dosage sold for "12hr". 180mg is the "24hr" dosage.
        
       | jmalicki wrote:
       | The article is extremely short, but comparing 2-4 OTC doses of
       | diphenhydramine to a level of alcohol concentration above what
       | constitutes a DUI in most places seems like an odd choice? Or is
       | that just a matter of proof of concept, go for the big obvious
       | demonstration first?
        
         | runnerup wrote:
         | 2 doses of diphenhydramine can have very noticeable and
         | profound effects on many people, 50mg total isn't a light dose
         | by any metric. That seems fine as a comparison to 0.1% BAC.
         | 
         | But 60mg Fexofenadine makes no sense to me in comparison. It's
         | usually 180mg in a single pill.
        
           | sjmm1989 wrote:
           | Hate to break it to you, but 50mg is pretty much a common
           | dosage for most people taking Diphen. At least where I lived
           | over the past few decades... This is mostly due to the effect
           | of 'if 1 pill is almost enough to do the job, then 2 pills
           | should be adequate'. You see this a lot with people who take
           | Tylenol and/or Advil. Tylenol overdoses are more common
           | because of the frequency of acetaminophens use in other
           | medications in combination with people taking Tylenol not
           | realizing they are doubling/tripling their doses.
           | 
           | So having people end up driving on 50mg+ doses of the dryl is
           | not uncommon in places like Canada. Pair it with a dose or
           | two of pseudoephidrine hydrochloride as well, and you
           | basically have a breath easy cocktail that _might_ put you to
           | sleep, or _might_ keep you awake all night.
        
         | pharrington wrote:
         | The directions I'm looking at for a store brand diphenhydramine
         | say to take 1-2 of the 25mg tablets as needed, so I'd expect
         | that's the typical therapeutic dose.
        
         | [deleted]
        
         | lazide wrote:
         | Having done that for awhile once? It basically is, and that is
         | the typically OTC recommended dose.
        
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