Nonprescription Medication Guidelines for Transplant Patients
About Nonprescription Medications
Nonprescription (Over-The-Counter) medicines do not require a doctor’s prescription for purchase, but they do have real effects and should be used with caution. This is especially true for patients who have received a transplant. This handout contains information to help you safely get the greatest benefit from OTC medicines. It will provide recommendations about which OTC medicines have the fewest possible interactions or side effects.
If any of the information in this handout causes you special concern or if you want more information about your medicine and its use, check with your doctor, nurse or pharmacist.
Remember to keep all medicines out of the reach of children. Never share your medicines with others.
Before Choosing an OTC Medicine
Tell your doctor, nurse, and pharmacist if you:
- Are allergic to any medicine, either prescription or nonprescription (OTC)
- Are pregnant or intend to become pregnant while using this medicine
- Are breast-feeding
- Are taking any other prescription or nonprescription (OTC) medicine or herbal products
- Have any other medical problems, especially diabetes
Take OTC medicines only as long as recommended on the package directions or as directed by your doctor. Do not take more of it and do not take it more often or for a longer period of time than directed. OTC products help relieve symptoms, but are not cures. If your symptoms do not improve in 2 or 3 days, begin to worsen, or if you have a fever or chills, contact your doctor.
Recommended OTC Medicines
Headache, Fever, and Body Aches
Acetaminophen (Tylenol®) can help relieve mild pain and fever. The maximum daily dose of acetaminophen is 4000 mg. If you have had a liver transplant, the dose should not exceed 2000 mg per day for 3 days in a row. Higher doses can harm your liver. Many products may contain acetaminophen; check labels for the amount in each.
Avoid nonsteroidal anti-inflammatory drugs (NSAIDs) because they can harm your kidney or interact with certain immunosuppressants. Common NSAIDs are: ibuprofen (Advil®, Motrin®, Midol® Cramp Formula), naproxen (Aleve®) and ketoprofen (Orudis KT®). Also avoid taking aspirin unless your doctor prescribed it. Aspirin is in some combination pain relievers, such as Excedrin® or Bayer®.
Sneezing, Itching and Runny Nose
Antihistamines are effective and, as a rule, safe to use. Loratadine (Claritin®) and cetirizine (Zyrtec®) are preferred because it causes the least drowsiness. Cromolyn (NasalCrom®) is another option to prevent allergy symptoms. It works best if you begin using it at least 1 week before you are in contact with possible allergens. Diphenhydramine (Benadryl®) and chlorpheniramine (Chlor-trimeton®) are other options, but are best used at bedtime because they cause more drowsiness. Talk to your doctor before using an antihistamine if you have glaucoma, an enlarged prostate or trouble urinating.
Avoid combination (multi-symptom) cold, sinus, and flu products (TheraFlu®, Nyquil®). It is better to treat each symptom alone. Accidental overdoses sometimes occur when patients duplicate therapy. If one of these products cannot be avoided, make sure to read the label carefully and get the advice of your doctor or pharmacist.
Nasal and Sinus Congestion
Topical nasal sprays are the most helpful for congestion. Topical decongestants such as oxymetazoline (Afrin®) and phenylephrine (Neosynephrine®) should not be used for more than three days because longer use can cause more congestion. Sodium chloride 9.9% (Ocean® spray) can be used safely long-term to keep nasal passages moist. SinuCleanse® is another product that relieves allergies, nasal congestion, and inflammation of the sinuses. It is a saline solution that can be used as a nasal washing through various devices or bottles.Oral decongestants, such as pseudoephedrine (Sudafed®) should be used cautiously because they can raise your blood pressure.
Oral decongestants, such as pseudoephedrine (Sudafed®) and phenylephrine (Sudafed PE®) should be used with care because they can raise your blood pressure. Make sure to check the list of active ingredients as pseudoephedrine and phenylephrine can be found in various cough and cold products.
Sore Throat
Most throat lozenges can be used safely. If you have diabetes, look for sugar-free products. Follow the label’s dosing recommendations carefully.
Chest Congestion
Guaifenesin (Robitussin®) is recommended for chest congestion. Coricidin® HBP Chest Congestion & Cough is another option that can make the cough more productive. Make sure to drink plenty of water to help loosen chest congestion.
Cough
Guaifenesin (Robitussin®) is also recommended for a cough with loose secretions. For a dry cough, the cough suppressant dextromethorphan (Delsym®) or a guaifenesin/DM combination (Robitussin DM®) can be used. Coricidin® HBP Chest Congestion & Cough can be used safely in patients with high blood pressure. Vicks® VapoRub ointment and Vicks® VapoSteam are different types of products that can relieve a cough for a time. If you have diabetes, look for a product free of sugar and alcohol. Use other Coricidin® HBP products, such as Cold & Flu and Maximum Strength Flu with care as they contain regular or extra-strength acetaminophen (Tylenol®).
Diarrhea
Loperamide (Imodium AD®) can be used for short-term treatment of diarrhea. It should not be used for longer than 48 hours. Pepto-Bismol® and Kaopectate® should be avoided because they may decrease the absorption of some immunosuppressive drugs. If your diarrhea is caused by an infection, you should not treat it with OTC products. If your diarrhea is heavy, bloody, or lasts for more than a day you should get medical attention.
Constipation
Recommended products include bulk-forming products (Metamucil®, Fiberall®); stool softeners, such as docusate (Colace®); and stimulants, such as bisacodyl (Dulcolax®), senna, or milk of magnesia (Phillip’s®); hyperosmotics, such as polyethylene glycol (MiraLAX®); and combinations of a stool softener with a stimulant such as docusate with senna (Senokot-S®). Long-term use of stimulant laxatives should be avoided because they may result in long-term diarrhea and changes in your electrolytes. If you remain constipated for more than 48 hours, please contact your doctor.
Stomach Upset
Stomach upset can be treated with calcium carbonate (TUMS®), ranitidine (Zantac®); famotidine (Pepcid AC®), nizatidine (Axid AR®) or omeprazole (Prilosec OTC®). Be careful not to take TUMS® or magnesium-containing products at the same time as some immunosuppressants such as mycophenolate (Cellcept® or Myfortic®), tacrolimus (Prograf®) or sirolimus (Rapamune®). Take the OTC products at least 1 hour before or 2 hours after the immunosuppressants. If you are having loose stools, avoid products containing magnesium such as Mylanta®, Mygel®, Maalox®, and Riopan® because they can make diarrhea worse. They may also cause your magnesium levels to get too high if your kidneys are not working properly. Avoid cimetidine (Tagamet®) because it has many drug interactions.
Gas
Simethicone (Gas-X®) is recommended for gas symptoms. If you have diabetes, you should avoid using Beano®. The safety of Beano® in patients with diabetes has not been studied. Beano® is used to prevent, not treat, gas symptoms.
Insomnia
Diphenhydramine (Benadryl®) and doxylamine (Unisom®) can be used occasionally to help you fall asleep. They should be used with care if at all in patients with glaucoma, enlarged prostate, or trouble urinating.
Dry Eyes and Eye Irritation
Artificial tears eye drops are recommended for the symptoms of dry eyes and eye irritation. Ketotifen (Zadiator®) eye drops are another option to prevent eye irritation for 8-12 hours. They should not be used for contact lens-associated irritation.
Nausea and Vomiting
Meclizine (Antivert®) can be used to treat and prevent symptoms of nausea and vomiting. Please tell your doctor before taking this medicine as you other medicines may have similar side-effects which could make you drowsier.
Joint Pain
Capsaicin cream (Capzasin-P®) can be used as a topical pain reliever. It provides temporary relief of muscle, joint pain, and back pain by desensitizing an area to pain. The cream may cause an uncomfortable burning sensation in the area since the main ingredient comes from chili peppers. Wear gloves while applying capsaicin cream.
Skin Irritation, Insect Bites and Poison Ivy
Topical corticosteroids, such as hydrocortisone cream (Cortisone-10®), are highly recommended for the treatment of skin irritation, insect bites, and poison ivy. Use of corticosteroids should be short term. If the condition worsens or if the symptoms persist for more than 7 days, stop using the medicine and consult your doctor.
Precautions While Using OTC Products
Check the labels of all nonprescription and prescription medicines you now take. Many OTC medicines sold for different uses have the same active ingredients. If you are taking multiple medicines, read labels carefully to lessen the risks of an accidental overdose.
Many drugs contain sweeteners. Patients with diabetes should look for sugar-free products. In the ingredient list sugar may appear as sugar, honey, dextrose, fructose, high fructose corn syrup, lactose, sorbitol, or mannitol. Calorie-free sweeteners include aspartame, acesulfame potassium, and saccharin.
Be careful not to take OTC products when on prescription drugs of the same kind.
Avoid products that have high alcohol content, such as Nyquil®.
The use of herbal medicines is not recommended. These products are not regulated by the FDA and may contain contaminants and impurities. Also, many herbals have been shown to interact with your immunosuppressive medicines.
Do not use phenazopyridine (Azo-Standard®) to treat undiagnosed urinary tract pain. This product treats painful symptoms but not the source of the infection. Such use could lead to serious delays in proper diagnosis and treatment
Do not use callus, corn or wart removers. Leave treatment of these problems and foot infections to your doctor or podiatrist.
Possible Side Effects of OTC Medicine
Possible side effects for nonprescription medicines are listed on the instruction sheet that comes with the product.
References:
Ellington T, Wipke-Tevis D, Messina C, Livesay T. The use of over-the-counter medication by transplant recipients: a guideline. J Transplant Coordination. 1999;9:17-24.
Raglin Quartetti H. FAQs on OTCs. Diabetes Forecast. 2004;57(2):68-71.
Roberts SS. 20 Questions. Diabetes Forecast. 2004;57(2):57-61.
The Spanish version of this Health Facts for You is #6520.
OTC Quick Guide
Symptoms |
Recommendation |
Headaches, fever & body aches |
Acetaminophen (Tylenol®) |
Sneezing, itching or runny nose |
Loratadine (Claritin®), Cetirizine (Zyrtec®), Cromolyn (NasalCrom®) |
Nasal & sinus congestion |
Nasal sprays: Oxymetazoline (Afrin®), Phenylephrine (Neosynephrine®) Sodium chloride (Ocean®), (SinuCleanse®) Pseudoephedrine (Sudafed®) |
Chest congestion |
Guaifenesin (Robitussin®), Coricidin® HBP Chest Congestion & Cough |
Productive cough |
Guaifenesin (Robitussin®) |
Dry cough |
Dextromethorphan (Delsym®) Guaifenesin/Dextromethorphan (Robitussin DM®) CoricidinÒ HBP Chest Congestion & Cough |
Sore throat |
Lozenges |
Constipation |
Psyllium (Metamucil®), Docusate (Colace®), Docusate with senna (Senokot-S®), Bisacodyl (Dulcolax®) Polyethylene glycol MiraLAX®), Senna |
Diarrhea |
Loperamide (Imodium AD®) |
Insomnia |
Diphenhydramine (Benadryl®), Doxylamine (Unisom®) |
Stomach upset |
Calcium carbonate (TUMS®) |
Heartburn |
Ranitidine (Zantac®) Famotidine (Pepcid AC®) Nizatidine (Axid®) Omeprazole (Prilosec OTC®) |
Gas |
Simethicone (Gas-X®) |
Dry eyes and eye irritation |
Artificial Tears, Ketotifen (Zadiator®) |
Nausea & vomiting |
Meclizine (Antivert®) |
Joint Pain |
Capsaicin cream (Capzasin-P®) |
Skin irritation, insect bites, poison ivy |
Hydrocortisone (Cortisone-10®) |
Common brand names are listed in parenthesis. Generic products are available for some products, and may be used instead of the brand name product. Read labels carefully to make sure you are getting the same active ingredient.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 03/05/2012
Reproduced, with permission, from the 1989-2009 United State Pharmacopeial Convention, Inc. Printed in 2012 by the University of Wisconsin Hospitals and Clinics Authority, Department of Nursing, Madison, WI. Reviewed by Department of Pharmacy. UWH #6161
Print Health Fact For You