The Benadryl challenge is killing teens. Here’s what you should know about it

An Ohio teen died this month after partaking in the Benadryl challenge, a viral TikTok trend in which users take between 12 to 14 pills with the goal of inducing hallucinations. The incident highlights the need for physicians and caregivers to educate children on the proper use of over-the-counter (OTC) medications, and why this is important.^[]

What Is the Benadryl challenge?

The Benadryl challenge is a dangerous TikTok trend first condemned by the Food and Drug Administration (FDA) in September 2020 after the agency reported they were aware of “teenagers ending up in emergency rooms or dying” from the challenge.^[]

In its 2020 statement, the FDA urged consumers, parents, and caregivers to:

• Store Benadryl and other OTC drugs out of sight and reach of young children.

• Lock up medications that have high abuse potential.

The FDA also urged healthcare providers to:

• Educate themselves on the Benadryl challenge.

• Educate patients, parents, and caregivers on the challenge.

• Educate patients on the importance of taking OTC drugs as directed.

The FDA at that time “strongly urge[d]” TikTok to remove Benadryl challenge videos from its app, and TikTok responded by banning the hashtag from the app.^[] The agency also noted the increased importance of education and surveillance during pandemic lockdown periods, as children and teens are “home more often due to the COVID-19 pandemic and may be more likely to experiment.”

But while, in most places, COVID-19 lockdowns have been lifted, the challenge hasn't let up. Here’s why it may be still occurring, how to talk to patients about risk reduction, and how to intervene if risks have already occurred.

Why don’t teens know better?

To an educated physician or adult, consuming too much Benadryl is undoubtedly harmful. For younger children and teens, though, this fact may be less obvious.

Nate Wood, MD, an instructor of medicine and medical education fellow at the Yale School of Medicine, contrasts this with the infamous Tide Pod challenge. In the Tide Pod challenge, Wood says there were fewer questions about risks and dangers—detergent isn’t meant to be consumed. He adds that this isn’t such a clear statement with over-the-counter (OTC) medications, as they are intended for consumption at directed dosages.

“Everyone knows that even consuming one Tide Pod can be harmful, but for most folks consuming one pill of Benadryl is not going to be harmful,” says Wood. “A lot of times patients get lulled into a false sense of thinking that over-the-counter medications are safe at any dose.”

Further, anyone can buy Benadryl from a local drugstore which can increase risks of misconceptions forming—and chances that people who aren't educated on the potential risks get ahold of the drug, he adds. 

How to prevent OTC drug abuse?

It’s easy for people to get their hands on Benadryl and other OTC drugs, and hard to keep them away from them. Especially for teens engaging in the challenge, preventing use isn’t as simple as locking the medications in a high-up cabinet. They can probably reach it and unlock it, too, if determined.

Instead, risk reduction may need to start with education on the correct dosages for OTC drugs and why this is important.

“We talk quite casually about over-the-counter medications because we as adults understand that high doses of these over-the-counter medications still can be exceedingly dangerous or, in some cases, deadly,” says Wood. “But I don’t think the teens understand that.”

This misunderstanding isn’t one person’s fault, nor is it one person's solution, he adds.

“I think it gets into a bigger cultural issue, that we don't necessarily prioritize talking to kids about how to maintain our health,” Wood says. “ It’s tough enough trying to feed them healthy food, get adequate sleep, and keep grades up. Talking in addition about how to use medications appropriately, how to promote health and wellness—it’s something we don't prioritize enough.”

He adds that both parents and doctors can have conversations with kids and teens about OTC medication use and should emphasize that while these medications “are useful tools but they are not risk-free.”

How to respond to a Benadryl overdose

If it is suspected that a teen or child overdosed on Benadryl, those with them should call poison control immediately and/or take them to the emergency room, Wood says. Primary care physicians should direct patients to emergency care or act accordingly if trained in emergencies.

How to treat a Benadryl overdose 

Managing a Benadryl overdose requires recognizing symptoms and administering treatment that matches them. A quick way to identify symptoms is to use the “ABC’s” acronym, Wood says.

A:  Airway

• If there’s anything obstructing the person’s airway, get it out. 

B: Breathing

• If they aren’t breathing, they may need to be put on a ventilator or given oxygen.

C: Circulation

• Take blood pressure and pulse 

Treating a Benadryl overdose could include things like stomach pumps, although, for most patients, the Benadryl may have already metabolized/dissolved, making a stomach pump unhelpful, Wood says.

He adds that other symptoms of Benadryl overdose that fall outside the ABC’s and can be potentially life-threatening can include:

Seizures

• These can be treated with benzodiazepines.

Tachycardia

• People's heart rate can be assessed with an electrocardiogram. If unusual changes occur, they may need to be treated with medications like sodium bicarbonate or magnesium.^[]

Hyperthermia

• Some patients may come in with a very high body temperature that needs to be remedied with cooling blankets or ice packs.

In most cases, Benadryl can clear the body in about four to six hours. But for people who take extreme doses, this time may be longer and lasting repercussions could be more extreme, including permanent brain damage, Wood says.^[]

The hope is that things don’t come to this and they can “go back to their life as normal,” Wood says.