The Hazards of the TikTok Benadryl Challenge

Social media has revolutionized the way we share information, both for better and for worse. Over the past decade, there has been a surge in Internet challenges that pose significant risks to children. From the infamous cinnamon challenge in 2012 to the Tide Pod challenge in 2016 and the nutmeg challenge in 2020, these viral trends have resulted in severe harm to young individuals. They have spread like wildfire through various platforms such as YouTube, Facebook, and, more recently, TikTok.

TikTok, a social media platform that allows users to view and share short videos tailored to their interests, has gained immense popularity since its launch in 2017. With over 1 billion users worldwide, it has become a center for entertainment and even public health messaging. However, just like any other social media platform, TikTok is not immune to misinformation. What is particularly concerning is that 32.5% of TikTok users are teenagers, who are impressionable and likely to engage in various challenges they come across on the platform.

One such challenge that gained traction on TikTok was the “Benadryl challenge.” In August 2020, Johnson & Johnson, the makers of Benadryl, issued a warning after a 15-year-old girl died from ingesting a large amount of diphenhydramine, the active ingredient in Benadryl. This challenge encouraged users to consume excessive amounts of diphenhydramine to experience a high and document their reactions. Subsequently, numerous cases of diphenhydramine poisoning emerged, prompting the US Food and Drug Administration to issue a warning in September 2020.

Diphenhydramine toxicity and treatment

Diphenhydramine, a first-generation antihistamine, has been around since 1946. It works by blocking histamine and muscarinic receptors in the body. The antimuscarinic effects of diphenhydramine contribute to its potential for abuse. In fact, the abuse of antimuscarinic agents, including diphenhydramine, has been documented for centuries. The recent shift, however, is towards self-harm, with a significant increase in reported cases among individuals aged 10 to 25 in the United States since 2011.

READ  TikTok's Data Controversy: A Deep Dive

The symptoms of diphenhydramine toxicity are primarily due to its antagonism of muscarinic receptors. This can lead to a range of effects, including increased heart rate, dry mouth, dilated pupils, urinary retention, flushed skin, and delirium. Not all patients will exhibit the full spectrum of symptoms, but many will experience delirium and dilated pupils without an increased heart rate. Sedation and an increased risk of seizures are also common due to the antihistaminic effects of diphenhydramine. Moreover, the drug can block sodium and potassium channels in the heart, potentially causing dangerous heart rhythm abnormalities.

Treatment for diphenhydramine toxicity is mainly supportive. Agitation and seizures are typically managed with benzodiazepines. In cases where patients have QRS segment prolongation on an electrocardiogram, sodium bicarbonate may be administered to counteract the effects of diphenhydramine on the heart. Physostigmine, a reversible inhibitor of acetylcholinesterase, can be used to relieve delirium and agitation by increasing the amount of acetylcholine in the brain. However, the use of physostigmine varies among healthcare providers depending on their comfort and regional practices. Monitoring the heart, respiratory system, and urinary function is crucial during treatment, and creating a calm environment can help reduce agitation. Most patients will recover within 24 hours.


It is imperative for pediatricians to be aware of and discuss the risks associated with challenges like the TikTok Benadryl challenge. This dangerous trend has already resulted in death and significant morbidity. Early recognition of signs and symptoms of diphenhydramine toxicity, along with proper supportive management using benzodiazepines, sodium bicarbonate, and, if necessary, physostigmine, is crucial for positive outcomes. For assistance, healthcare professionals can reach out to their local poison centers by calling 800-222-1222.

READ  Marketing Your Business on TikTok: A Pro Account Guide


  1. Health hazards associated with laundry detergent pods – United States, May-June 2012. MMWR Morb Mortal Wkly Rep. 2012;61(41):825-829.
  2. Atherton RR. The “Nutmeg Challenge”: a dangerous social media trend. Arch Dis Child. Published online July 3, 2020. doi:10.1136/archdischild-2020-319407
  3. Grant-Alfieri A, Schaechter J, Lipshultz SE. Ingesting and aspirating dry cinnamon by children and adolescents: the “cinnamon challenge”. Pediatrics. 2013;131(5):833-835. doi:10.1542/peds.2012-3418
  4. Ostrovsky AM, Chen JR. TikTok and Its Role in COVID-19 Information Propagation. J Adolesc Health Off Publ Soc Adolesc Med. 2020;67(5):730. doi:10.1016/j.jadohealth.2020.07.039
  5. Eghtesadi M, Florea A. Facebook, Instagram, Reddit and TikTok: a proposal for health authorities to integrate popular social media platforms in contingency planning amid a global pandemic outbreak. Can J Public Health Rev Can Sante Publique. 2020;111(3):389-391. doi:10.17269/s41997-020-00343-0
  6. Clement J. Distribution of TikTok users in the United States as of June 2020, by age group. Published online November 6, 2020. Accessed November 11, 2020.
  7. FDA. FDA warns about serious problems with high doses of the allergy medicine diphenhydramine (Benadryl). Published September 24, 2020.
  8. Gummin DD, Mowry JB, Spyker DA, et al. 2018 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 36th Annual Report. Clin Toxicol Phila Pa. 2019;57(12):1220-1413. doi:10.1080/15563650.2019.1677022
  9. Spiller HA, Ackerman JP, Smith GA, et al. Suicide attempts by self-poisoning in the United States among 10-25 year olds from 2000 to 2018: substances used, temporal changes and demographics. Clin Toxicol (Phila). 2020;58(7):676-687. doi:10.1080/15563650.2019.1665182
  10. Isbister GK, Oakley P, Dawson AH, Whyte IM. Presumed Angel’s trumpet (Brugmansia) poisoning: clinical effects and epidemiology. Emerg Med Fremantle WA. 2003;15(4):376-382. doi:10.1046/j.1442-2026.2003.00477.x
  11. Palmer RB, Reynolds KM, Banner W, et al. Adverse events associated with diphenhydramine in children, 2008-2015. Clin Toxicol (Phila). 2020;58(2):99-106. doi:10.1080/15563650.2019.1609683
  12. Arens AM, Shah K, Al-Abri S, Olson KR, Kearney T. Safety and effectiveness of physostigmine: a 10-year retrospective review. Clin Toxicol (Phila). 2018;56(2):101-107. doi:10.1080/15563650.2017.1342828
  13. Boley SP, Olives TD, Bangh SA, Fahrner S, Cole JB. Physostigmine is superior to non-antidote therapy in the management of antimuscarinic delirium: a prospective study from a regional poison center. Clin Toxicol Phila Pa. 2019;57(1):50-55. doi:10.1080/15563650.2018.1485154
  14. Burns MJ, Linden CH, Graudins A, Brown RM, Fletcher KE. A comparison of physostigmine and benzodiazepines for the treatment of anticholinergic poisoning. Ann Emerg Med. 2000;35(4):374-381. doi:10.1016/S0196-0644(00)70057-6
  15. Watkins JW, Schwarz ES, Arroyo-Plasencia AM, Mullins ME. The Use of Physostigmine by Toxicologists in Anticholinergic Toxicity. J Med Toxicol Off J Am Coll Med Toxicol. 2015;11(2):179-184. doi:10.1007/s13181-014-0452-x
READ  Is TikTok Putting More Than Just Your Time at Risk?

Related Posts