Guide to over-the-counter medications for kidney ...

Renal Transplant Clinic 61 Queen Street East, 9th Floor

Toronto, ON Tel: 416-867-3665, option 2

Fax: 416-867-3740

GUIDE TO OVER-THE-COUNTER MEDICATIONS FOR KIDNEY TRANSPLANT PATIENTS

Over-the-counter (OTC) medications are medications that you can choose yourself in the drug store without a prescription from your doctor. They are used to help relieve various symptoms such as headaches, pain, cough and allergies. 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. The information below tells you which medication you can take and which medications you should avoid. Always follow the directions carefully and ask your doctor or pharmacist if you have any questions.

PAIN, FEVER, AND BODY ACHES

Avoid all over the counter non-steroidal anti-inflammatory drugs (NSAIDs) due to the potential for these drugs to cause kidney failure and worsen high blood pressure. Common NSAIDs are: ibuprofen (Advil?, Motrin?) and naproxen (Aleve?).

Avoid high doses of salicylates as they may also cause kidney problems. It is generally safe to use a low dose Aspirin (81 mg or 325 mg once daily) for prevention of heart disease and stroke.

For transplant recipients, acetaminophen (Tylenol?) is the medication of choice for pain management. Do not exceed a daily dose of 4,000 mg or 2,000 mg if you have liver disease. Many products contain acetaminophen, check labels for the dose in each.

SNEEZING, ITCHING AND RUNNY NOSE

Antihistamines are effective and generally safe to use. Loratadine (Claritin?), fexofenadine (Allegra?) and cetirizine (Reactine?) cause the least drowsiness.

Diphenhydramine (Benadryl?) and chlorpheniramine are best used only as needed and at bedtime because they can cause drowsiness, dry mouth, blurry vision and constipation.

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. It is better to treat each symptom separately.

NASAL AND SINUS CONGESTION

Topical nasal sprays are the effective for congestion. Nasal sprays such as oxymetazoline (Afrin?) or xylometazoline (Otrivin?) should not be used for more than three days because longer use can cause more congestion.

Oral decongestants, such as pseudoephedrine (Sudafed?) and phenylephrine (Sudafed? PE) should NOT be used 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 preparations.

Sodium chloride nasal sprays can also help with congestion and are safe to use.

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SORE THROAT

Most throat lozenges are safe to use. Look for sugar-free products if you have diabetes.

COUGH AND CHEST CONGESTION

Guaifenesin (Robitussin?DM Chest Congestion) is recommended for chest congestion and can make the cough more productive. It is also a good option for a cough with loose secretions.

For a dry cough, the cough suppressant dextromethorphan (Delsym DM?, Vicks NyQuil Cough Liquid?) can be used.

Vicks? VapoRub ointment and Vicks? VapoSteam are different types of products that can temporarily relieve cough and chest congestion.

If you have diabetes, look for sugar-free and alcohol-free products.

DIARRHEA

Loperamide (Imodium?) can be used for short-term treatment of diarrhea. Do not exceed 48 hours. Avoid Pepto-Bismol? and Kaopectate? because they can cause kidney problems. If your diarrhea is caused by an infection, do not treat it with OTC products. If your diarrhea is heavy, bloody, or lasts for more than a day, contact your transplant center to seek

help.

CONSTIPATION

The following products can be used: o Bulk-forming laxatives: Metamucil?, take your medications at least 4 hours before or 2 hours after Metamucil?. o Stool softeners: docusate (Soflax?, Colace?) o Stimulants: bisacodyl (Dulcolax?), senna (Senokot?), milk of magnesia o Hyperosmotics: polyethylene glycol (PegaLAX?, Lax-A-Day?) o Combinations of a stool softener with a stimulant: docusate with senna (Senokot-S?)

Avoid long-term use of stimulant laxatives (more than one week) because they may cause dependence, result in long-term diarrhea, and changes in your electrolytes.

DRY EYES AND EYE IRRITATION

Artificial tears eye drops are recommended for the symptoms of dry eyes and eye irritation.

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STOMACH UPSET/HEARTBURN

Stomach upset can be treated with calcium carbonate (TUMS?, Rolaids?), ranitidine (Zantac?), famotidine (Pepcid AC?).

Be careful not to take calcium or magnesium-containing products at the same time as some immunosuppressants such as mycophenolate (Cellcept? or Myfortic?). Take these products at least 4 hours before or 2 hours after the immunosuppressants.

If you are having loose stools, avoid products containing magnesium because they can make diarrhea worse. They may also cause your magnesium levels to get too high.

GAS

Simethicone (Gas-X?) is recommended for gas symptoms. If you have diabetes, you should avoid using Beano?. The use of Beano? will produce an additional two

to six grams of carbohydrates for every 100 grams of food. Beano? is used to prevent, not treat, gas symptoms.

SUNBLOCK

Due to the increased risk of skin cancer seen in transplant patients receiving immunosuppressive therapy, use of a minimum SPF 30 broad spectrum UVA/UVB sunblock is strongly recommended while outside.

GRAPEFRUIT JUICE

Consumption of grapefruit , grapefruit juice and fruit juice blends containing grapefruit juice should be avoided. Grapefruit inhibits the metabolism of tacrolimus, cyclosporine and sirolimus and causes the levels of these drugs to increase predisposing patients to toxicity and kidney failure.

HERBAL MEDICATIONS

If you were taking herbal medications/dietary supplements prior to transplant, have your pharmacist review them post-transplant. Many herbal products can interact with immunosuppressant medications and the immune system. Particularly avoid the use of Ginseng, St. John's Wort, and Echinacea.

ANTIBIOTICS

If you get a prescription for an antibiotic listed below from a doctor or dentist, please ask them to call the transplant clinic for a discussion of an alternative. o Erythromycin (Eryc?) or Erythrocin o Clarithromycin (Biaxin?) o Rifampin (Rifadin?, Rofact?) o Ketoconazole

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OTC QUICK GUIDE

SYMPTOMS

RECOMMENDATION

Pain, fever & body aches Sneezing, itching or runny nose

Nasal & sinus congestion Chest congestion Productive cough Dry cough Sore throat

Constipation

Diarrhea Stomach upset Heartburn Gas Dry eyes and eye irritation

Acetaminophen (Tylenol?)

Loratadine (Claritin?) Fexofenadine (Allegra?) Cetirizine (Reactine?)

Nasal sprays: Oxymetazoline (Afrin?), Xylometazoline (Otrivin?) Sodium chloride nasal spray

Guaifenesin (Robitussin? DM Chest Congestion)

Guaifenesin (Robitussin? DM Chest Congestion)

Dextromethorphan (Delsym DM?, Vicks NyQuil Cough Liquid?)

Lozenges

Psyllium (Metamucil?) Docusate (Soflax?, Colace?) Docusate with senna (Senokot-S?) Bisacodyl (Dulcolax?) Polyethylene glycol (PegaLAX?, Lax-A-Day?) Senna (Senokot?)

Loperamide (Imodium?)

Calcium carbonate (TUMS?, Rolaids?)

Ranitidine (Zantac?) Famotidine (Pepcid AC?)

Simethicone (Gas-X?)

Artificial Tears

*Common brand names are listed in parentheses. 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. This list is not all inclusive.

This guide is developed by Natalia Persad, Pharmacy Student and Helen Fanous Pharm.D

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