I don’t know about you, but when I conceptualize over-the-counter medications, I think they're generally safe for people to take. They don’t require a prescription, people take them often, and the list goes on.To some degree, that’s true. But it’s important to know that over-the-counter (OTC) medication is still medication; it's still going to have side effects and interactions. On that note, doctors want to warn about a particular OTC med that may harm your brain health, the science behind the risk and safer alternatives to consider.?SIGN UP for tips to stay healthy & fit with the top moves, clean eats, health trends & more delivered right to your inbox twice a week?
The medication ingredients in question are doxylamine succinate, which is found in certain sleep aids (like Unisom) and allergy medications, like first-generation antihistamines (such as hydroxyzine, or Vistaril/Atarax, and diphenhydramine, or Benadryl. It can have cognitive side effects in the long term and short term, though the former are more serious—think increased dementia risk.“Doxylamine succinate, a first-generation antihistamine, can have negative impacts on brain health, especially when patients use high doses, frequently and for a long period,” confirms Dr. Duyen Nguyen, DO, an allergist at Memorial Hermann.Immediate impacts, she says, include confusion, drowsiness and dizziness. Prolonged use, however, can lead to cognitive decline, memory loss, increased risk of dementia and delirium, especially in older patients.Related: This 3-Minute Habit Could Help You Sleep Through the Night
Dr. Sanjay Kamboj, MD, an associate professor of medicine and an allergy and immunology specialist at LCMC Health, agrees. “Cumulative use over time may lead to neurodegenerative changes or exacerbate existing risk factors for dementia,” he says. “Short-term, occasional use of doxylamine in healthy adults is generally considered safe, with mild and temporary side effects such as dry mouth, drowsiness or grogginess.”The former has been noted in research, too: A 2015 study in JAMA Internal Medicine concluded “higher cumulative anticholinergic use is associated with an increased risk for dementia.” But how does it happen?
“These medications block acetylcholine, a neurotransmitter essential for memory, attention and learning,” explains Dr. Chris Allen, MD, sleep science advisor at Aeroflow Sleep, a board-certified sleep medicine physician and a pediatric neurologist. “Over time, this interference may contribute to structural and functional changes in the brain.”
Dr. Deanna McDanel, PharmD, a clinical pharmacy specialist in UI Health Care’s Allergy/Immunology Clinic, adds that “acetylcholine is a key chemical involved in promoting wakefulness and arousal,” so naturally, when it’s blocked, a person might feel drowsy or sedated.Other common risks that doctors mention include daytime drowsiness, cognitive impairment and somnolence, or severe drowsiness. Further, the latter can impair mental alertness and increase the risk of falls or accidents, Dr. McDanel says.
Related: New Study Reveals Surprising Factor That May Increase Dementia Risk
This is particularly true for older adults who take this medication. “In older adults, reduced brain reserve makes them more vulnerable to these effects,” Dr. Kamboj explains.
In fact, Dr. Nguyen would say it’s “very risky” for elderly patients to take a high dosage of doxylamine succinate for a prolonged period. The level of risk depends on the dose, duration and individual factors, McDanel adds, like age, other medications taken and overall brain health.
Within certain parameters, it *can* be safe—and even helpful and recommended. “Generally speaking, doxylamine can be safe when used in the lowest effective dose for the shortest duration possible,” Dr. McDanel says. “It is even recommended fairly regularly for pregnant women to help with nausea as it is effective for this, along with vitamin B6, and is safe for the fetus.”
Since the safety profile is so individualized, your best bet is to talk to your primary care provider, who knows your history.
It’s also worth noting that when it comes to sleep, medication may not be the answer we would assume it to be. “They don’t provide the deep, restorative sleep that our brains need,” Dr. Allen says. “In fact, they can disrupt the natural sleep architecture, leading to less REM sleep, which is crucial for memory consolidation and emotional regulation.”
Safer, Effective Alternatives
If you need more long-term support with allergies or sleep, other options are probably safer bets. Ahead, doctors share tips and treatments to consider.
Try a newer antihistamine, like loratadine (Claritin), cetirizine (Zyrtec) or fexofenadine (Allegra). Dr. Allen says they're generally safer because they don’t cross the blood-brain barrier as easily and have fewer side effects.
Second-generation antihistamines are also less likely to make you drowsy, a major complaint with first-generation antihistamines. “Allergists often recommend these over first-generation antihistamines due to the lower chance of causing sedation, while maintaining the same, if not more, clinical efficacy for treating allergic conditions,” Dr. McDanel adds.
She also encourages steroid nasal sprays, addressing underlying medical conditions and talking to your healthcare provider.
Additionally, Dr. Nguyen mentions prescription medication, such as montelukast, and allergy shots. “Allergy immunotherapy (allergy shots) is the most effective treatment for moderate to severe allergies,” she adds.
Related: FDA Warns of Newly Identified ‘Severe’ Risk of Popular Over-the-Counter Allergy Medications
For sleep
If you struggle with sleep, Dr. Allen has several suggestions. His first recommendation is cognitive behavioral therapy for insomnia (CBT-I). “This is the gold standard for chronic sleep problems,” he says.
Sleep hygiene is still important too. Need a refresher on what that looks like? Dr. Allen encourages the following:
Establishing a consistent sleep routineLimiting screen time before bedAvoiding stimulants late in the dayCreating a cool, dark sleeping environment Talking to a doctor about medication (or supplements) if necessaryDr. Nguyen agrees that CBT-I and good sleep habits are good options. “This is considered the safest way to treat insomnia,” she explains.
And again, this long-term concern about doxylamine and brain health doesn’t mean the medication is totally off limits. “Occasional use (e.g., for a bad cold or jet lag) is not known to pose major harm in healthy adults,” Dr. Kamboj says. “The concern arises with habitual or long-term use, particularly in older individuals.”
Up Next:
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Sources
Dr. Duyen Nguyen, DO, an allergist Dr. Sanjay Kamboj, MD, an allergy and immunology specialist Dr. Chris Allen, MD, a board-certified sleep medicine physician and a pediatric neurologistDr. Deanna McDanel, PharmD, a clinical pharmacy specialist Cumulative Use of Strong Anticholinergics and Incident Dementia, JAMA Internal Medicine Read More Details
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