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Diphenhydramine’s Role in Death Investigations: An Examination of Diphenhydramine Prevalence in 2 US Geographical Areas

Botch-Jones, Sabra Ruvera MS, MS, MA*; Johnson, Robert PhD; Kleinschmidt, Kurt MD; Bashaw, Samantha MFS§; Ordonez, Jhonny MD

The American Journal of Forensic Medicine and Pathology: September 2014 - Volume 35 - Issue 3 - p 181–185
doi: 10.1097/PAF.0000000000000106
Case Reports

Purpose Diphenhydramine (DPH), an over-the-counter first-generation H1 receptor antagonist, is not a common drug of abuse; however, it is encountered in cases of overdose both in the clinical setting and in death investigations. The toxicology laboratories in the Tarrant County Medical Examiner’s Office and the District of Columbia Office of The Chief Medical Examiner analyze antemortem and postmortem specimens. Presented are the findings of this evaluation and detailed histories of cases involving DPH.

Methods Toxicology reports, autopsy reports, and death investigator narratives were obtained in cases involving DPH at toxic and lethal levels in which this compound was the primary cause or a contributing factor in the death.

Results Blood concentrations were quantified at a range of 2870 to 21,263 ng/mL. A rare occurrence of DPH abuse via documented intravenous administration leading to death is presented. The cases presented here generally involved much higher concentrations of DPH and an older population than those in previous published data regarding DPH’s role in death investigation and abuse.

Conclusions As people seek legal alternative drugs to abuse and with the ease of obtaining information via online forums, there is a potential to see an increase in the number of cases involving excessive use of DPH.

From the *fTox Consulting, LLC, Woburn, MA; †Tarrant County Medical Examiner’s Office, Fort Worth; †Medical Toxicology, University of Texas Southwestern Medical Center, Dallas, TX; §District of Columbia, Office of the Chief Medical Examiner, Washington, DC; ∥Parkland Health and Hospital System, Dallas, TX.

Manuscript received December 3, 2013; accepted April 20, 2014.

The authors report no conflicts of interest.

Reprints: Sabra Ruvera Botch-Jones, MS, MS, MA, fTox Consulting, LLC, 12 Green St 1, Woburn, MA 01801. E-mail:;

© 2014 by Lippincott Williams & Wilkins.