More threads by David Baxter PhD

David Baxter PhD

Late Founder
Over-the-counter sleep meds not effective: FDA
CBC News
Wednesday, May 5, 2010

Combination products in question

The FDA says over the counter sleep aids using acetaminophen in combination with diphenhydramine citrate failed to show any significant benefit.

The U.S. Food and Drug Administration had data 15 years ago showing over-the-counter sleep aid products such as Tylenol PM and Excedrin PM don't offer a significant benefit to patients, according to a letter obtained by CBC News. The products use a combination of the painkiller acetaminophen and diphenhydramine citrate, which is a sleep aid. The letter was written by the director of the Office of Nonprescription Products at the Center for Drug Evaluation and Research at the FDA.

In the February 16, 2010, letter to the Consumer Healthcare Products Association, which represents the nonprescription drug industry, Dr. Charles Ganley rejects an industry sponsored study submitted to the Food and Drug Administration in 1995.

"FDA has reviewed the submission and concluded the study results do not demonstrate a contribution of both ingredients to the efficacy of the combination for OTC relief of occasional sleeplessness when associated with minor aches and pains," Ganley says in the letter.

According to the FDA, combination products such as the sleep aids must show a benefit over any single ingredient.

It's not clear why the FDA took 15 years to evaluate the industry's research. Dr. Ganley's letter appears to be the first response from the FDA since the data was submitted on March 17, 1995.

The study was a multi-centre, randomized, placebo-controlled trial conducted in the early 1990s. An analysis of the data suggests the combination products are statistically better than a placebo but not by much.

"We conclude that there is an insufficient basis to support the combination of acetaminophen and diphenhydramine as a nighttime sleep aid for the relief of occasional sleeplessness when associated with minor aches and pains," the letter goes on to tell drug makers.

The U.S. authority has not raised any concerns about the safety of the medications.

It has, however, invited the drug companies to conduct further research. The FDA says it needs two studies showing efficacy of the combination products.

The Consumer Healthcare Products Association has not returned calls from the CBC.
 

Retired

Member
Diphenhydramine is an antihistamine, originally marketed under the brand name Benadryl. It's use was to relieve allergic reactions.

Source: Diphenhydramine

Diphenhydramine is used to relieve red, irritated, itchy, watery eyes; sneezing; and runny nose caused by hay fever, allergies, or the common cold. Diphenhydramine is also used to relieve cough caused by minor throat or airway irritation. Diphenhydramine is also used to prevent and treat motion sickness, and to treat insomnia (difficulty falling asleep or staying asleep). Diphenhydramine is also used to control abnormal movements in people who have early stage parkinsonian syndrome (a disorder of the nervous system that causes difficulties with movement, muscle control, and balance) or who are experiencing movement problems as a side effect of a medication.

Diphenhydramine will relieve the symptoms of these conditions but will not treat the cause of the symptoms or speed recovery. Diphenhydramine should not be used to cause sleepiness in children. Diphenhydramine is in a class of medications called antihistamines. It works by blocking the action of histamine, a substance in the body that causes allergic symptoms.

Products sold over the counter containing diphenhydramine:


Brand names
  • AllerMax?
  • AllerMax? Caplets?
  • Benadryl?
  • Benadryl? Allergy
  • Benadryl? Allergy Chewables Children' s
  • Benadryl? Allergy Kapseals?
  • Benadryl? Allergy Ultratab?
  • Benadryl? Dye-Free Allergy Children' s
  • Benadryl? Dye-Free Allergy Liqui-Gels?
  • Compoz? Nighttime Sleep Aid
  • Compoz? Nighttime Sleep Aid Gelcaps?
  • Diphen? AF Elixir
  • Diphenhist?
  • Diphenhist? Captabs?
  • Diphenhydramine Hydrochloride Caplets?
  • Excedrin P.M.? Caplets?
  • Excedrin P.M.? Geltabs?
  • Excedrin P.M.? Tablets
  • Genahist?
  • Genahist? Elixir
  • Goody's? PM Powder
  • Hydramine? Cough Syrup
  • Hydramine? Elixir
  • Miles? Nervine Nighttime Sleep-Aid
  • Nytol? QuickCaps? Caplets?
  • Nytol? Quickgels? Maximum Strength
  • Simply Sleep? Nighttime Sleep Aid Caplets?
  • Sleepinal? Night-time Sleep Aid Softgels?
  • Sominex? Caplets?Maximum Strength
  • Sominex? Nighttime Sleep Aid
  • Twilite? Caplets?
  • Unisom? SleepGels? Maximum Strength

Brand names of combination products
  • Alka-Seltzer PM? Pain Reliever and Sleep Aid (containing Diphenhydramine Citrate and Aspirin)
  • Bayer? PM Extra Strength Caplets? (containing Diphenhydramine Hydrochloride and Aspirin)
  • Benadryl? Allergy & Cold Caplets? (containing Diphenhydramine Hydrochloride, Acetaminophen, and Pseudoephedrine Hydrochloride)
  • Benadryl? Allergy & Cold Fcontaining Diphenhydramine Citrate and Pseudoephedrine Hydrochloride)
  • Benadryl? Allergy & Sinus (containing Diphenhydramine Hydrochloride and Pseudoephedrine Hydrochloride)
  • Benadryl? Allergy & Sinus Children's (containing Diphenhydramine Hydrochloride and Pseudoephedrine Hydrochloride)
  • Benadryl? Allergy & Sinus Fcontaining Diphenhydramine Citrate and Pseudoephedrine Hydrochloride)
  • Benadryl? Allergy & Sinus Headache Caplets? Maximum Strength (containing Diphenhydramine Hydrochloride, Acetaminophen, and Pseudoephedrine Hydrochloride)
  • Benadryl? Severe Allergy & Sinus Headache Caplets? Maximum Strength (containing Diphenhydramine Hydrochloride, Acetaminophen, and Pseudoephedrine Hydrochloride)
  • Doan's? P.M. Extra Strength Caplets? (containing Diphenhydramine Hydrochloride and Magnesium Salicylate)
  • Legatrin PM? Caplets? (containing Diphenhydramine Hydrochloride and Acetaminophen)
  • Percogesic? Aspirin-Free Caplets? Extra Strength (containing Diphenhydramine Hydrochloride and Acetaminophen)
  • Sine-Off? Night Time Relief Sinus Cold & Flu Medicine GelCaplets? (containing Diphenhydramine Hydrochloride, Acetaminophen, and Pseudoephedrine Hydrochloride)
  • Sominex? Pain Relief Formula (containing Diphenhydramine Hydrochloride and Acetaminophen)
  • Sudafed? Sinus Nighttime Plus Pain Relief Caplets? (containing Diphenhydramine Hydrochloride, Acetaminophen, and Pseudoephedrine Hydrochloride)
  • Tylenol? Allergy Sinus NightTime Maximum Strength Caplets? (containing Diphenhydramine Hydrochloride, Acetaminophen, and Pseudoephedrine Hydrochloride)
  • Tylenol? Allergy-D Children's (containing Diphenhydramine Hydrochloride, Acetaminophen, and Pseudoephedrine Hydrochloride)
  • Tylenol? Flu NightTime Maximum Strength Gelcaps? (containing Diphenhydramine Hydrochloride, Acetaminophen, and Pseudoephedrine Hydrochloride)
  • Tylenol? PM Extra Strength Caplets? (containing Diphenhydramine Hydrochloride and Acetaminophen)
  • Tylenol? PM Extra Strength Gelcaps? (containing Diphenhydramine Hydrochloride and Acetaminophen)
  • Tylenol? PM Extra Strength Geltabs? (containing Diphenhydramine Hydrochloride and Acetaminophen)
  • Tylenol? Severe Allergy Caplets? (containing Diphenhydramine Hydrochloride and Acetaminophen)
 

David Baxter PhD

Late Founder
I think the FDA objection here is primarily that the combination drugs don't yield any advantage.

The article questions why now, 15 years later... I suspect that may have to do with renewed concerns abiut the amount of Tylenol (acetominophen) North Americans are consuming and the inherent dangers in that. Adding Tylenol to Benadryl doesn't make you any sleepier; it's overkill, with potentially an emphasis on the "kill" part.
 

Retired

Member
Acetaminophen (Tylenol and all other brands of acetaminophen) have long been touted as the safer alternative to aspirin and more recently to ibuprofen (Advil etc) for pain relief. While acetaminophen is claimed to less likely cause stomach upset than the other two, there is real danger to liver damage when more than the recommended dose of acetaminophen is taken.

According to the FDA, combination products such as the sleep aids must show a benefit over any single ingredient.

When I posted my response listing diphenhydramine containing products, I first thought the objection was to the overuse of this antihistamine, which has been criticized over the years for being used indiscriminately in over the counter preparations for sleep and weight loss, but I overlooked the statement about combined drug use.

While there may be justification for concerns about the over use of diphenhydramine, the issue being addressed here, as you point out, is the use of combinations. Current medical thinking is of the opinion that most combined medications do not offer any benefit and may even be disadvantageous, when compared to single compound (targetted) formulations.

One can only speculate about the marketing rationale of combining acetaminophen with diphenhydramine to be marketed as a sleep aid. One theory might be that marketing an antihistamine alone over the counter may not have the same market appeal as combining it with an already popular and widely accepted pain reliever. Marketing studies probably showed a significant number of people have difficulty falling asleep because of various kinds of pain, a not uncommon complaint, ranging from over exertion to an improper bed.

J&J created a need through advertising, then offered a product that could be sold over the counter.

It's only been in recent yeas that data has emerged (publicly) that acetaminophen overdose can be hazardous, which might explain for the FDA's fifteen year delay to address the issue.
 
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