From Chapter 6: Antihistamines Did you know a simple non-prescription allergy pill can cause your character to hallucinate and even die? Originally developed in the 1940s, antihistamines are used to dry up runny noses, combat allergy symptoms (like itching), quiet coughs, and help with insomnia. They are in cold pills, allergy tablets, and sleep aids. But, used wrong, they can also be lethal. Just taking a few times more than the typical daily dose can cause serious symptoms, including hallucinations, seizures, and death. Medical professionals use a mnemonic to help remember the symptoms from an antihistamine overdose: dry as a bone, blind as a bat, red as a beet, full as a flask, hot as a hare, and mad as a hatter. Sidebar: Dry as a bone (dry mouth) Blind as a bat (blurry vision) Red as a beet (flushed red skin) Full as a Flask (can't urinate) Hot as a hare (increased body temperature) and Mad as a hatter (delirious, hallucinations) Would you be surprised to learn that diphenhydramine, a popular non-prescription antihistamine, ranks among the top 10 to 15 drugs used in overdose deaths, not far behind drugs like fentanyl? Before 2020, most diphenhydramine overdoses were involved in attempted suicide cases. However, in 2020 a widely-viewed social medica challenge urged viewers to take high diphenhydramine doses to experience hallucinations. Unfortunately, since taking enough diphenhydramine to cause hallucinations can also be lethal, several teens in the US died from participating in the challenge. Sidebar: Common allergy tablets cause your character to hallucinateor die There are several "generations" of antihistamines. The so-called "first" generation are the older, sedating antihistamines, like diphenhydramine. The newer generations, like loratadine, claim to cause less sedation. While all antihistamines can be dangerous in high doses, the risks differ with various generations and can get complicated. Because of this, the simplest approach will be to avoid specifics, such as naming the drug. Instead, let your reader fill in the details, as your character opens a box of allergy medicine, slowly popping each pink pill from the blister pack, while remember her troubles, then scooping them all into her hand and swallowing. As the scene progresses, your character should develop a number of the symptoms typical of an antihistamine overdose, such as drowsiness, confusion, and seeing those spiders on the wall. You'll hook that reader, while avoiding getting a wrong drug-symptom combination. Slang Terms Street Names DPH, drill, dryl, pink dreamz Weaving The Plot How is it used? Diphenhydramine is available in tablets or liquids labeled as allergy medicine, sleep aid, or cough syrup. The pills come in safety blister packs as well as bulk bottles. (It's also available in combination cold tablets, but because those also contain several other drugs, the overdose picture can be more complex and is best avoided for these scenes). In medical facilities, this antihistamine is also given as an injection, especially in urgent situations, such as during severe allergic reactions. Diphenhydramine creams (used to stop itching) don't absorb through skin, so don't have your character rub some on a rash and start hallucinating. Sidebar: Don't have your character hallucinate after using an anti-itch cream Now you try it-- Writing Prompt #1: Write a scene as one of your characters gets ready for work. Between a runny nose, constant sneezing, and itchy eyes, allergies are making the character miserable. With a big presentation to the company's boss due this morning, the character grabs a bottle of allergy pills and pours some out. Surely, a few extra pills will help hold off those allergies through the presentation, right? (You'll continue this in Writing Prompt #2). How will my character act or feel? At normal doses, your character will feel drowsy and have a dry mouth. Elderly characters, though, will have more pronounced effects, even at normal doses, such as difficulty thinking, sleepiness, and stumbling. Is a character drinking alcohol with the antihistamines? Have symptoms dramatically increase. An overdose of diphenhydramine will cause many of the symptoms described in the mnemonic. At first, your character will be drowsy, with some difficulty concentrating. She can be lucid enough to answer questions, but the words will be garbled from a mouth so dry it will feel like it's stuffed with cotton balls. Symptoms can progress to extreme sleepiness, confusion, rambling thoughts, and hallucinations. She'll be agitated and her vision will be blurry. Her agitation can get worse, as she desperately swipes at imaginary bugs on her skin or cries out at the spiders crawling on the wall. Her skin should be flushed and hot from fever, but don't have her clothes damp from perspiring. High antihistamine doses stop the body from cooling itself down by sweating. As her temperature soars, she can collapse from seizures, her limbs jerking and foam dripping from her clenched mouth. Without emergency medical care, you character can end up in a coma or die from a fatal irregular heartbeat. Even with medical care, if her temperature isn't brought down rapidly, she can suffer long-term brain damage. Permanent (see Appendix). Excerpted from The Grim Reader: A Pharmacist's Guide to Putting Your Characters in Peril by Miffie Seideman All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.
