Sominex
Sominex is the trademarked name for several over the counter sleep aids.
Different formulations of Sominex are available, depending upon the market. Both the US and UK formulations contain a significant dose of a first generation antihistamine with hypnotic properties.
In the United States, Sominex is marketed by Prestige Brands,[1] sometimes under their subsidiary Medtech Products, Inc.,[2] and has as its active ingredient diphenhydramine hydrochloride.[3] It is sometimes repackaged by Navajo Manufacturing Co., Inc. using the label Handy Solutions.[4]
Diphenhydramine hydrochloride is also marketed as an antihistamine in Canada under the same name, and is only listed in the Canadian Agricultural database for equine use.[5] However, a 2019 manual for counseling professionals in Canada included Sominex as a medicine to be used for the treatment of Parkinson's tremors and stiffness related to the condition in addition to its usage as an antihistamine.[6]
In the UK, Sominex's active ingredient is promethazine hydrochloride.[7] In 2024, the medicine is marketed by Teva UK Limited.[8]
In India, the Sominex name is used by Lunar BioPharma Pvt. Ltd. to market a nutritional supplement intended to provide gastrointestinal relief.[9] This version of Sominex is unrelated to the US and UK formulations;[citation needed] however, the US version repackaged by Navajo Manufacturing Co., Inc. is sold through GNH India.[10][non-primary source needed]
Diphenhydramine and promethazine are both marketed by names other than Sominex for several indications including and besides their use as sleep aids. For example, diphenhydramine is sold under the brand name Benadryl as an antihistamine for use against allergies.[11] Tylenol PM contains diphenhydramine in addition to acetaminophen for the purpose of inducing sleep and reducing pain and/or fever.[12] Promethazine is marketed by the brand name Phenergan for use against allergy symptoms and motion sickness in the US, where a prescription for promethazine is required.[13]
History
United States
As early as the 1950s, Sominex was being promoted in television commercials. One ad spot featured the image of the sleeping pill tablet itself as a classic bouncing ball to follow the lyrics of their jingle, shown on the lower third of the screen.[14] The commercial aired on a 1958 episode of the Arthur Murray Party.[15]
In 1959, Sominex was noted as one of the major brands pushing patent medicines in television ads.[16] Congressman John Blatnik had previously revealed that the manufacturer of Sominex, Pharmaceuticals, Inc., was selling lemon-flavored skim milk under the brand name of RDX, US¢7 product they sold for US$3.00 per bottle.[17]
As early as 1960, Sominex was advertised as having been hospital-tested in newspapers.[18]
In 1971, Sominex was a combination of scopolamine aminoxide hydrobromide, methapyrilene hydrochloride, and salicylamide,[19] the last of which is noted as a pain killer,[20] and comprised the largest part of the formula.[21] This formula was still in use in 1975,[22][23] 1977,[24] and in 1982.[25] A survey of elderly patients between 1978 and 1980 identified the formula as containing aminoxide-methapyrilene.[26] It was produced by J.B. Williams Co., Inc., who also made Sominex 2.[22]
The FDA requested that the National Cancer Institute speed up testing on over-the-counter drugs containing methapyrilene in 1978 as a result of a preliminary study showing tumors in test animals given the drug.[27] The study combined methapyrilene and nitrite in high doses before giving them to rats who then developed liver tumors.[28][29] In 1979, Health and Human Services (formerly Health, Education, and Welfare) Secretary Joseph A. Caliphano Jr. asked the FDA to remove such drugs, including Sominex, from the market.[30] A statement from a Williams Co. spokesman in 1978 had indicated that Sominex had always contained methapyrilene.[31]
By June 1979, J.B. Williams Co. was marketing Sominex with pyrilamine, a drug that had not been tested for possible carcinogenic effects and had last been deemed safe for humans in FDA testing completed in the 1940s.[32] The FDA recommended banning the use of pyrilamine maleate, potassium bromide, sodium bromide, and scopolamine hydrobromide that same year unless they could be proven safe and effective; as a result, most sleep aid drug manufacturers changed their formulas to stop using it.[33]
At some point before 1986, the Sominex formula had changed to diphenhydramine.[26]
On January 17, 1989, the FDA approved the use of diphenhydramine hydrochloride and diphenhydramine citrate;[34] by then, Sominex and Sominex 2 both used at least one of these two chemical compounds.[33] The list of unapproved chemicals for use as a sleep aid included not only those recommended for banning in 1979, but several others including acetaminophen, aspirin, and passion flower extract.[34]
Pharmaceutical manufacturer GlaxoSmithKline owned the Sominex brand in 2011, and announced their decision to divest it in April 2011.[35] Prestige acquired Sominex, along with 16 other brand names, from GlaxoSmithKline in December 2011 for US$661.6 million.[36]
Sominex 2
In July 1975, the J.B. Williams Co. began marketing Sominex 2.[37] On November 24, 1975, Attorney General Evelle J. Younger filed suit on behalf of the State of California against Williams Co., stating that the product did not warn against use by pregnant or nursing women or persons with asthma or COPD, nor did it notify consumers that it should not be used in conjunction with alcohol.[38] The California Department of Health ordered Williams Co. to immediately cease sales of Sominex 2, which the company refused to do.[38]
On December 2, 1975, the FDA ordered Sominex 2 - which included diphenhydramine - to be removed from the market because the packaging was not child-resistant and the label did not include necessary warnings.[22] They also stated that the use of diphenhydramine in an OTC drug was illegal.[37] The FDA subsequently issued a recall for all outstanding Sominex 2 stock.[39]
Television advertisements for Sominex 2 in 1983, manufactured by Beecham, made specific claims as to the effectiveness and physician preference for diphenhydramine.[40]
United Kingdom
In the UK, Actavis marketed promethazine hydrochloride under the Sominex name.[41] It was available at least as early as 1985 as an OTC hypnotic.[42]
Actavis also marketed a product by the name of Sominex Herbal, an herbal sleep aid with three natural active ingredients: hops, valerian, and passion flower extracts.[43]
Competing with GSK in the UK, Actavis ran an ad in 2010 for Sominex — their first television promotional campaign for the drug — in an attempt to increase the market share for their formulation of Sominex.[44]
In 2018, Actavis withdrew Sominex from the market, according to the HPRA.[45] In 2024, the medicine is marketed by Teva UK Limited.[8]
Recalls
The promethazine formula of Sominex was included in a recall issued in 2010 in the United Arab Emirates by Ministry of Health and Prevention Ministerial Decree No. 366 before receiving approval.[46]
Side-effects
Current U.S. formula
As a first-generation antihistamine, diphenhydramine is considered to be a sedative. Clinic trials of this class of drug versus a placebo have shown that the medication can affect attention, motor control, and memory.[47]
It has been described as causing euphoria, hallucinations and psychosis, as well as tachycardia, blurred vision, and hyperactivity, among numerous other effects. Chronic use has been shown to cause dependence with large dosages.[48]
Older U.S. formulas
In 1969, Washington Hospital Center discovered four patients in their care who were suffering from scopolamine toxicity, their symptoms mimicking schizophrenia.[49] In 1964, Sominex use resulted in severe reactions for six patients who suffered hallucinations and disorientation.[49]
In 1972, Sominex included methapyrilene, a drug known to cause nausea, vomiting, hypotension and central nervous system depression, among other effects, when taken in excess.[50]
The formula used in 1975 included scopolamine, a hallucinogen rather than a sedative, which an FDA panel found to be an ineffective sleep aid at the manufacturer-recommended dosage as well as potentially deadly, with higher dosages possibly causing delirium and violence, and possibly leading to paralysis, coma, or death.[51] The 306-page report compiled by 7 experts was presented to the FDA on December 4, 1975.[52] Regular scopolamine use was also linked to the development of glaucoma.[51]
In 1976, physostigmine was recommended as a treatment for toxicity of drugs with anticholinergic properties, including Sominex.[53]
Current U.K. formula
In elderly people, the side effects have been shown to include dry or sticky lips, urinary issues, pale or dry skin, falling without cause, blurry vision, anxiety, tachycardia, or cardiac arrhythmia.[54]
Adverse interactions
A case in Canada revealed that patients taking medication for chronic schizophrenia may experience tardive dyskinesia when taking Sominex in a manner other than prescribed.[55]
When taking psilocybin, patients have reported increased blood pressure (but not hypertension).[56]
Effectiveness
Current U.S. standing
The American Academy of Sleep Medicine stated in 2018 that they could not recommend OTC sleep aids, specifically listing Sominex as an example, as there have not been enough studies regarding their effectiveness.[57]
Historical U.S. standing
An investigation conducted by Dr. Anthony Kales, a leading U.S. sleep researcher at the time, into the efficacy of Sominex at least as early as 1971 found that Sominex did not cause test patients to fall asleep, nor did it have any effect on moderate to severe insomnia.[58][19]
In 1971, FDA Commissioner Dr. Charles Edwards testified before Congress that Sominex, as it was then-formulated in the U.S., was no more effective than a placebo and noted that some users could experience hallucinations. He also stated that manufacturer advertisements exaggerated the benefits, use, and effectiveness of OTC drugs.[59]
A U.S. Senate memorandum sent to Senator Gaylord Nelson in 1975 revealed that while over US$34 million had been spent on sleeping aids in 1974, Sominex and its competitor Compoz were shown to be ineffective when compared to placebos.[60]
Historical U.K. standing
Promethazine has been determined at 20mg dosages to increase sleep duration through apparent direct effect on the brain rather than simply clearing congestion.[42]
Questions of misuse
United States
At a conference in 1972, it was acknowledged that people abused Sominex for hallucinogenic effects.[61] Out of 13,787 cases reported of OTC drugs consumed by children under five in 1973, only 58 were ascribed to Sominex.[62]
In 1986, a patient who had taken 1600 mg of Sominex 2 daily for a period of one month led his physicians to question whether additional caution should be taken with respect to abuse potential.[63]
In 2005, diphenhydramine was included on a list of first-generation antihistamines that could be used to self-prescribe for mild anxiety and mild depression, with the caveat that self-medicating is only part of self-management of a medical issue.[64]
An FAA report found that between 2012 and 2016, diphenhydramine was the most common pharmaceutical known to cause impairment detected in post-mortem toxicology tests performed on someone who may have been in charge of the aircraft at the time of a fatal plane crash, specifically naming both Benadryl and Sominex.[65]
A 2016 recommendation regarding possibly misused over-the-counter medications indicated that the generic diphenhydramine had the potential to be over-utilized by patients and suggested changing it to a behind-the-counter class drug.[66]
A 2023 Forbes report on the use of diphenhydramine for canine allergies listed several brand names, including Benadryl and Sominex, noting that veterinarians will use the medicine off-label to treat dog allergies but that it has not been FDA approved for use in non-humans.[67]
Interviews presented in an October 2023 Netflix documentary (The Devil on Trial) covering the alleged demonic possession of Arne Johnson suggested that Sominex abuse may have caused the appearance of possession.[68] An interview following the documentary's release with the medical director of UCI Health Sleep Medicine Services revealed that no studies have been done regarding the Sominex brand's possible long-term effects as it is only intended for short-term use.[69]
United Kingdom
A study of deaths from 2000 to 2019 reported to the National Programme on Substance Abuse Deaths showed that 27.3% of deaths showing a first-generation antihistamine on the toxicology report indicated promethazine abuse.[70]: Table 1 It questioned the apparent understanding that P classification antihistamines aren't dangerous while showing an increase in the number of deaths reported involving apparent abuse of those same drugs over the span of 20 years.[70]
References
- ^ Ranii, David (21 December 2011). "GSK sells BC, Goody's and other brands". News & Observer. Archived from the original on 15 April 2012.
- ^ "SOMINEX- diphenhydramine hydrochloride tablet, film coated". DailyMed. Retrieved 16 April 2024 – via National Library of Medicine.
- ^ "Mother To Baby | Fact Sheets [Internet]: Diphenhydramine". National Library of Medicine. January 2023. Retrieved 16 April 2024.
- ^ "SOMINEX- diphenhydramine hydrochloride tablet". DailyMed. Retrieved 16 April 2024 – via FDA.
- ^ "Elimination Guidelines (April 3, 2023)". Government of Canada. Retrieved 16 April 2024.
- ^ Csiernik, Rick (2009). The Essential Guide to Psychoactive Drugs in Canada: A Resource for Counselling Professionals (2nd ed.). Ontario: Canadian Scholars. p. 82. ISBN 9781773381602.
- ^ "Sominex" (PDF). Medicines.org UK. Retrieved 16 April 2024.
- ^ a b "Sominex Tablets". Medicines.org UK. Retrieved 16 April 2024.
- ^ "Lunar Biopharma". lunarbio.com. Archived from the original on 13 October 2012. Retrieved 17 January 2022.
- ^ "Diphenhydramine Hydrochloride (Sominex)". GNH India. Retrieved 16 April 2024.
- ^ "Diphenhydramine: drowsy (sedating) antihistamine". National Health Service. 21 September 2018. Retrieved 1 November 2023.
- ^ "Label: TYLENOL PM EXTRA STRENGTH- acetaminophen and diphenhydramine hydrochloride tablet, film coated". DailyMed. Retrieved 16 April 2024 – via National Library of Medicine.
- ^
- "Promethazine (Phenergan)". National Health Service. Retrieved 16 April 2024.
- Southard, Brittin T.; Al Khalili, Yasir (1 January 2024). "Promethazine". StatPearls [Internet]. Retrieved 16 April 2024 – via National Library of Medicine.
- ^ Sominex commercial 1958 (Commercial). Sominex. 21 May 2012. Archived from the original on 9 August 2013. Retrieved 14 April 2018 – via YouTube.
- ^ Sominex commercial on the Arthur Murray Dance Party 1958 (Commercial). NBC (published 18 May 2020). 1958. Retrieved 15 April 2024 – via YouTube.
- ^ Anderson, Jack (3 November 1959). "Man Behind the Medicine". The Post Register, Idaho Falls. Vol. 29, no. 3. p. 4 – via NewspaperArchive.com.
- ^ Anderson, Jack (3 November 1959). "Quiz Boosts Sales". The Post Register, Idaho Falls. Vol. 29, no. 3. p. 4 – via NewspaperArchive.com.
- ^ "New Way to End Sleepless Nights ...Safely*Taken as directed". New York Daily News. Vol. 1, no. 257. 20 April 1960. p. 19 – via Newspapers.com.
- ^ a b Fass, Grace (December 1971). "Sleep, Drugs, and Dreams". American Journal of Nursing. 71 (12): 2316–2320. doi:10.2307/3422235. JSTOR 3422235. PMID 5209451. S2CID 22422200.
- ^ Weil, Henry (13 February 1977). "Do your sleeping pills really work?". The Daily News. pp. 8, 9, 16 – via Newspapers.com.
- ^ Montgomery, Jerry (28 June 1978). "Sleeping aids − What's in those tablets?". The Santa Fe New Mexican. Vol. 129, no. 194. Gannett. p. 10 – via Newspapers.com.
- ^ a b c "FDA Orders Sominex 2 Withdrawn From Market". Richmond Times-Dispatch. Vol. 125, no. 336. 2 December 1975. p. 2. Retrieved 16 April 2024 – via Newspapers.com.
- ^ Morrant, J.C.A. (June 1975). "Medicines and Mental Illness in Old Age". Canadian Psychiatric Association Journal. 20 (4): 247–324. doi:10.1177/070674377502000412. ISSN 0008-4824. PMID 1182644. S2CID 27695558.
- ^ "Few Beers Before Test?". Barstow Desert Dispatch. Vol. 64, no. 298. 9 April 1977. p. 3 – via NewspaperArchive.com.
- ^ National Research Council (US) Panel on Anticholinergic Chemicals (1982). Possible Long-Term Health Effects of Short-Term Exposure to Chemical Agents: Volume 1 Anticholinesterases and Anticholinergics (Report). Washington D.C.: National Academies Press. p. Appendix B. Retrieved 16 April 2024 – via National Library of Medicine.
- ^ a b Stewart, Ronald B.; May, Franklin E.; Moore, Mary T.; Hale, William E. (August 1989). "Changing Patterns of Psychotropic Drug use in the Elderly: A Five-Year Update". DICP: The Annals of Pharmacotherapy. 23 (7–8): 610–613. doi:10.1177/1060028089023007-821. ISSN 1042-9611. PMID 2569792. S2CID 33206308. See table 2.
- ^ "Sleep aids testing beefed up". Racine Journal Times. Vol. 122, no. 162. 13 June 1978. p. 21 – via Newspapers.com.
- ^ Lijinsky, W.; Reuber, M.D.; Blackwell, B.N. (August 1980). "Liver tumors induced in rats by oral administration of the antihistaminic methapyrilene hydrochloride". Science. 209 (4458): 817–9. Bibcode:1980Sci...209..817L. doi:10.1126/science.7403848. PMID 7403848.
- ^ "FDA Plans Ban Of Sleeping Pills". Florida Today. Vol. 13, no. 84. 13 June 1978. p. 11A – via Newspapers.com.
- ^ "Many sleep aids expected to be off market by June". The Modesto Bee. Vol. 102, no. 127. 7 May 1979. p. 7 – via Newspapers.com.
- ^ "FDA Seeks Restrictions On Sleeping Aid Drugs". Daily Press. Vol. 83, no. 164. 13 June 1978. p. 1 – via Newspapers.com.
- ^ Cook, Christopher (28 June 1979). "Sleep aids back with new drug | Critics assail 'human testing'". The Minneapolis Star. pp. 1A, 6A – via Newspapers.com.
- ^ a b "FDA approves most sleep-aid ingredients". Arizona Daily Star. Vol. 148, no. 45. 14 February 1989. p. 6 – via Newspapers.com.
- ^ a b 54 FR 6826
- ^ Rausch, Tim (14 April 2011). "Drugmaker GlaxoSmithKline to sell Aiken facility". The Augusta Chronicle. Associated Press. Retrieved 16 April 2024.
- ^
- Amato, Michael (18 January 2012). "Prestige Brands Sets Rate on $620 Million Loan for Buyout". Bloomberg News. Retrieved 16 April 2024.
- "GlaxoSmithKline Sells North American Brands to Prestige Brands, Inc. for $661.6 Million Cash". BioSpace (Press release). 20 December 2011. Retrieved 16 April 2024.
- ^ a b Nocera, Joseph (17 December 1975). "No Chance This Year for Consumer Bill". Garden City Telegram. Vol. 47, no. 39. p. 24 – via Newspapers.com.
- ^ a b "Sominex Faces Suit by State". Oroville Mercury-Register. Vol. 101, no. 277. Sacramento. 25 November 1975. p. 2 – via Newspapers.com.
- ^ "Recall". The Herald-News. Vol. 104, no. 307. 29 December 1975. p. 15 – via Newspapers.com.
- ^ Graedon, Joe (5 December 1983). "Sleeping-ill ingredient taken from allergy drug". Springfield News-Leader. p. 4B – via Newspapers.com.
- ^ "What is Sominex? | Ingredients". Sominex Sleep UK. Archived from the original on 3 March 2011. Retrieved 16 April 2024.
- ^ a b Adam, Kirstine; Oswald, I. (December 1986). "The hypnotic effects of an antihistamine: promethazine". British Journal of Clinical Pharmacology. 22 (6): 715–717. doi:10.1111/j.1365-2125.1986.tb02962.x. PMC 1401211. PMID 3567016. S2CID 35326486.
- ^ "What is Sominex Herbal? | Ingredients". Sominex Sleep UK. Archived from the original on 3 March 2011. Retrieved 16 April 2024.
- ^ "Sominex counts on sheep for growth" (PDF). OTC Bulletin. 13 August 2010. p. 17. Retrieved 16 April 2024.
- ^ "Human Medicines Withdrawn Products" (PDF). Department of Health (Ireland). Retrieved 16 April 2024.
- ^ Restrictions in Use and Availability of Pharmaceuticals, 2010-2018 (Report). Geneva: World Health Organization. 1 January 2020. p. 164. ISBN 978-92-4-001477-0. JSTOR resrep48218.4.
- ^ Stein, Richard A.; Strickland, Tony L. (April 1998). "A Review of the Neuropsychological Effects of Commonly Used Prescription Medications". Archives of Clinical Neuropsychology. 13 (3): 259–284. doi:10.1016/S0887-6177(97)00027-9. PMID 14590642. S2CID 23375547.
- ^ Schifano, Fabrizio; Chiappini, Stefania; Miuli, Andrea; et al. (7 May 2021). "Focus on Over-the-Counter Drugs' Misuse: A Systematic Review on Antihistamines, Cough Medicines, and Decongestants". Frontiers in Psychiatry. 12: 657397. doi:10.3389/fpsyt.2021.657397. PMC 8138162. PMID 34025478. S2CID 233874257. See table 1.
- ^ a b Claiborne, William (1 October 1969). "Over-the-Counter Sleeping Pill's Side Effects Suspected". Courier News. Vol. 86, no. 89. p. 23 – via Newspapers.com.
- ^ Fatteh, Abdullah; Dudley, J.B. (7 February 1972). "Fatal Poisoning Involving Methapyrilene". JAMA. 219 (6): 756–757. doi:10.1001/JAMA.1972.03190320056027. PMID 4400422. S2CID 5329969.
- ^ a b Klotz, Neil (24 October 1975). "Finding Obtained From FDA: Are Pills And Tranquilizers Worth It?". Westminster College Parson. Vol. 1, no. 8. p. 9 – via Newspapers.com.
- ^ "Scientists report money wasted on sleeping pills and sedatives". The Daily Mail. Vol. 147, no. 287. Bridgerstown, MD. 6 December 1975. p. 6 – via Newspapers.com.
- ^ Micik, Sylvia (January 1976). "Anticholinergic Poisoning—New Antidote". Western Journal of Medicine. 124 (1): 50–51. PMC 129975. PMID 18747630. S2CID 38789858.
- ^ Mintzer, Jacobo; Burns, Alistair (September 2000). "Anticholinergic side-effects of drugs in elderly people". Journal of the Royal Society of Medicine. 93 (9): 457–462. doi:10.1177/014107680009300903. PMC 1298101. PMID 11089480. S2CID 43591230.
- ^ Jones, B; Lal, S (August 1985). "Tardive dyskinesia uncovered after ingestion of Sominex, an over-the-counter drug". The Canadian Journal of Psychiatry. 30 (5): 370–371. doi:10.1177/070674378503000514. eISSN 1497-0015. PMID 2862985. S2CID 37797680.
- ^ Bogenschutz, Michael P.; Ross, Stephen; Bhatt, Snehal; et al. (24 August 2022). "Percentage of Heavy Drinking Days Following Psilocybin-Assisted Psychotherapy vs Placebo in the Treatment of Adult Patients With Alcohol Use Disorder". JAMA Psychiatry. 79 (10): 953–962. doi:10.1001/jamapsychiatry.2022.2096. PMC 9403854. PMID 36001306. S2CID 251766399.
- ^ Carr, Teresa (12 December 2018). "The Problem With Sleeping Pills". Consumer Reports. Retrieved 16 April 2024.
- ^ Graedon, Joe (19 August 1979). "Sleeping Pill Reports Confirmed". Alexandria Daily Town Talk. Vol. 97, no. 156. p. E-7 – via Newspapers.com.
- ^ Kirkman, Don (22 July 1971). "Stricter Control of Drugs to Be Asked". Knoxville News Sentinel. No. 29, 075. p. 24. Retrieved 16 April 2024 – via Newspapers.com.
- ^ Anderson, Jack (17 October 1975). "Washington merry-go-round | Public service profitable for senator". Delphos Tri County Daily Herald. Vol. 106, no. 106. p. 6 – via NewspaperArchive.com.
- ^ Royer, Fred L. (Winter 1972). "State of the Science Report: Effects of Psychoactive Drugs on Behavioral Functions". Journal of Drug Issues. 2 (1): 29–33. doi:10.1177/002204267200200106. ISSN 0022-0426. S2CID 80052408.
- ^ Choate, Robert; Debevoise, Nancy (January 1976). "Caution! Keep This Commercial Out of Reach of Children!". Journal of Drug Issues. 6 (1): 91–98. doi:10.1177/002204267600600117. ISSN 0022-0426. S2CID 80315622.
- ^ Feldman, Marc D.; Behar, Marcy (13 June 1986). "A Case of Massive Diphenhydramine Abuse and Withdrawal From Use of the Drug". JAMA. 55 (22): 3119–3120. doi:10.1001/jama.1986.03370220081028. PMID 3702020. S2CID 20105532.
- ^ Barlow, Julie; Charlton, Bruce G. (9 September 2005). "Letter to the Editor | Self-management and pregnancy–safe interventions for panic, phobia and other anxiety-disorders might include over-the-counter (OTC) 'SSRI' antihistamines such as diphenhydramine and chlorpheniramine". Acta Psychiatrica Scandinavica. 112 (3): 323. doi:10.1111/j.1600-0447.2005.00611.x. PMID 16156843. S2CID 19105124.
- ^ Soper, John; Cliburn, Kacey; Hileman, Christy; Craft, Kristi; Kemp, Philip (31 December 2020). Comparative Evaluation of Forensic Toxicology Findings, 2012-2016 (PDF) (Report). Federal Aviation Administration. pp. 9–10. S2CID 265537577. Retrieved 17 April 2024.
- ^ Sansgiry, Sujit S.; Bhansali, Archita H.; Bapat, Shweta S.; Zu, Qingqing (19 December 2016). "Abuse of over-the-counter medicines: a pharmacist's perspective". Integrated Pharmacy Research and Practice. 6 (2017): 1–6. doi:10.2147/IPRP.S103494. PMC 5774309. PMID 29354545. S2CID 12160975. See tables 2 & 3.
- ^ Pal, Meera (22 September 2023). Smith, Kelly Anne (ed.). "Benadryl For Dogs: Safe Dosages And Uses". Forbes. Retrieved 16 April 2024.
- ^ Zornosa, Laura (18 October 2023). "The True Story Behind the Netflix Documentary The Devil on Trial". TIME. Retrieved 25 March 2024.
- ^ Lloyd, Sophie (18 October 2023). "'Devil on Trial' Shock Reveal—Can Sleeping Pills Really Mimic Possession?". Newsweek. Retrieved 31 March 2024.
- ^ a b Oyekan, Princess J.; Gorton, Hayley C.; Copeland, Caroline S. (17 March 2021). "Antihistamine-related deaths in England: Are the high safety profiles of antihistamines leading to their unsafe use?". British Journal of Clinical Pharmacology. 87 (10): 3978–3987. doi:10.1111/bcp.14819. PMID 33729599. S2CID 232262504.