Taking Over-the-Counter (OTC) Medicines Safely

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1 Taking Over-the-Counter (OTC) Medicines Safely

2 This chart contains information about some of the more frequent drug interactions that may occur when you are taking over-the-counter (OTC) medicines with prescription medicines. In order to take all of your medicines safely and effectively, always check the active ingredients of your OTC medicines, located on the label. Many OTC medicines contain more than one active ingredient, any of which may interact with your prescription or other OTC medicines that you may be taking. The information is provided for educational purposes only and should not replace the advice of your doctor. If you have any questions about these medicines, or before making changes to your drug regimen talk to your doctor or pharmacist.

3 Acid reducers for the temporary relief of indigestion, inflammation of the esophagus, acid reflux or ulcers cimetidine of OTC medicine: (Tagamet HB ) Cranberry products may reduce the effectiveness of acid reducers. continued on next page alprazolam, amitriptyline, imipramine nortriptyline, paroxetine, Risperdal, sertraline cyclosporine Flomax metformin, glipizide warfarin Tagamet HB may increase the effects of these medicines and may cause unwanted side effects. Check with your doctor or pharmacist before taking together to review potential side effects of these medicines. Tagamet HB may lead to confusion in older adults and is not usually recommended as the acid reducer of choice. Tagamet HB may interact with many different medicines. Always check with your doctor or pharmacist before taking with your other medicines. dofetilide (Tikosyn ) The use of these medicines together is not recommended and is usually avoided since it may have a harmful effect on the heart. Acid reducers

4 Acid reducers Acid reducers for the temporary relief of indigestion, inflammation of the esophagus, acid reflux or ulcers (continued) cimetidine alcohol Tagamet HB of OTC medicine: may increase the (Tagamet HB ) negative effects of alcohol. Cranberry products may reduce the effectiveness of acid reducers. from previous page carvedilol, diltiazem, flecainide, labetalol, metoprolol, pentoxyphylline, propranolol, Demerol, morphine Dilantin theophylline Zomig Tagamet HB may increase the effects of these medicines and may cause unwanted side effects. Check with your doctor or pharmacist before taking together to review potential side effects of these medicines. Tagamet HB may lead to confusion in older adults and is not usually recommended as the acid reducer of choice. Tagamet HB may interact with many different medicines. Always check with your doctor or pharmacist before taking with your other medicines.

5 Acid reducers for the temporary relief of indigestion, inflammation of the esophagus, acid reflux or ulcers (continued) of OTC medicine: Cranberry products may reduce the effectiveness of acid reducers. famotidine (Pepcid AC ) cyclosporine When used together the effect of the cyclosporine may be decreased. Check with your doctor before taking these medicines together because additional monitoring may be necessary. If you have kidney disease consult your doctor before taking Pepcid AC. Special dosing may be necessary. Sporanox Famotidine may decrease the effects of Sporanox. If taken together, it is recommended to take Sporanox with a cola beverage. Acid reducers

6 Acid reducers Acid reducers for the temporary relief of indigestion, inflammation of the esophagus, acid reflux or ulcers (continued) omeprazole carbamazepine of OTC medicine: (Prilosec OTC Cranberry products may reduce the ) diazepam effectiveness of acid reducers. digoxin methotrexate Pletal warfarin Prilosec OTC may increase the effects of these medicines and may cause unwanted side effects. Check with your doctor or pharmacist before taking together to review potential side effects of these medicines. Prilosec OTC does not work immediately to relieve symptoms. It may take a few days for the effects to be felt. ginkgo biloba, St John s Wort Plavix These herbal supplements may decrease the effectiveness of Prilosec OTC. Check with your doctor before taking together. Prilosec OTC may decrease the effect of Plavix and may increase the risk of blood clots. Check with your doctor before taking Plavix and Prilosec OTC together.

7 Acid reducers for the temporary relief of indigestion, inflammation of the esophagus, acid reflux or ulcers (continued) ranitidine (Zantac 75 ) glipizide of OTC medicine: Cranberry products may reduce the triazolam, Risperdal effectiveness of acid reducers. warfarin Sporanox Zantac 75 may increase the effects of these medicines when used together and may increase unwanted side effects. Check with your doctor or pharmacist before taking together to review potential side effects of these medicines. Zantac 75 may decrease the effects of Sporanox when used together. If taken together, it is recommended to take Sporanox with a cola beverage. If you have kidney disease consult your doctor before taking Zantac 75. Special dosing may be necessary. Acid reducers

8 Antacids Antacids for the temporary relief of indigestion, heartburn and/or sour stomach OTC Medicine Interacts with Effects of Interactions Safety tips/ possible side aluminum/magnesium Allegra effects of OTC medicine: Antacids may decrease the effects of (Gaviscon ) these medicines if taken together. It Check with your doctor or pharmacist allopurinol is best to speak with your doctor or about how to take your antacids with calcium carbonate captopril pharmacist to check when you different medicines. Antacids may (Tums ) decrease the effects of many different Cellcept should take these medicines. magnesium hydroxide medicines and may need to be taken at (Milk of Magnesia ) Crestor different times of the day to avoid a decreased effect. continued on next page digoxin K-Phos Cipro, Levaquin, tetracyclines levothyroxine, Levoxyl, Synthroid Neurontin Prevacid propranolol Sporanox ticlopidine Use caution when taking antacids containing calcium if you have or have had kidney disease or kidney stones. Antacids containing aluminum should not be taken if you have bone problems (such as osteoporosis) and should be avoided if you have Alzheimer s disease. Antacids containing: Calcium carbonate may cause constipation Magnesium may cause diarrhea

9 Antacids for the temporary relief of indigestion, heartburn and/or sour stomach (continued) OTC Medicine Interacts with Effects of Interactions Safety tips/ possible side aluminum/magnesium Prograf effects of OTC medicine: Antacids may increase the effects of (Gaviscon ) Prograf. Check with your doctor Check with your doctor or pharmacist before taking these medicines about how to take your antacids with calcium carbonate together because additional different medicines. Antacids may (Tums ) monitoring may be necessary. decrease the effects of many different magnesium hydroxide medicines and may need to be taken at (Milk of Magnesia ) different times of the day to avoid a decreased effect. from previous page Use caution when taking antacids containing calcium if you have or have had kidney disease or kidney stones. Antacids containing aluminum should not be taken if you have bone problems (such as osteoporosis) and should be avoided if you have Alzheimer s disease. Antacids containing: Calcium carbonate may cause constipation Magnesium may cause diarrhea Antacids

10 Antihistamines Antihistamines for allergies or the common cold. Temporarily relieves symptoms such as: runny nose, itchy eyes, itchy throat and/or sneezing OTC Medicine Interacts with Effects of Interactions Safety tips/ possible side diphenhydramine (Benadryl ) metoprolol The use of these medicines together may result in slowed heart rate, low blood pressure and fatigue. It is best to speak with your doctor about whether it is safe to take these medicines together. effects of OTC medicine: Ask your doctor before using antihistamines if you are taking medicines such as monoamine oxidase inhibitors (MAOI), antidepressants or anti-psychotics. Diphenhydramine may cause drowsiness, dry mouth and/or dry eyes.

11 Aspirin containing products for upset stomach of OTC medicine: bismuth subsalicylate doxycycline, Pepto-Bismol may decrease the Check with your doctor before using (Pepto-Bismol ) minocycline, effects of these antibiotics. If taken Pepto-Bismol if you have an allergy to tetracycline together, it is recommended to take aspirin or nonsteroidal anti-inflammatory the antibiotic 2-3 hours before the drugs (NSAIDs) such as naproxen or Pepto-Bismol. ibuprofen. It contains a form of aspirin and may also cause an allergic reaction. May cause a temporary darkening of stool and/or tongue. warfarin Taking Pepto-Bismol with warfarin may increase the risk of bleeding. Check with your doctor before using these medicines together. Call your doctor immediately if you have any unexplained bruising, bleeding gums, red or dark brown urine or black stools. Aspirin

12 Aspirin Aspirin for heart attack prevention Celebrex of OTC medicine: Taking aspirin with these medicines may increase the risk of developing a To avoid upset stomach, take with food or diltiazem stomach bleed. milk. Buffered aspirin (Bufferin ) Enteric coated aspirin (Ecotrin ) continued on next page diclofenac Orudis citalopram, Cymbalta, Lexapro Effexor, fluoxetine, paroxetine, Pristiq, sertraline gingko biloba verapamil warfarin ibuprofen Taking aspirin with these medicines may increase the risk of bleeding. Call your doctor immediately if you have signs of bleeding such as dark stools, bloody vomit, nose bleeds or unexplained bruising. Taking ibuprofen with aspirin may decrease the heart protection effects of the aspirin. If you take them together, it is recommended to take aspirin 30 minutes before taking ibuprofen or 8 hours after taking ibuprofen. Enteric coated aspirin which has a special coating) may reduce the risk of a stomach ulcer or bleed. Do not crush, chew or break enteric coated tablets. Check with your doctor before starting aspirin therapy if you have an allergy to aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen or ibuprofen. Call your doctor immediately if you experience: blood in your stool, vomit, or urine severe stomach pains trouble breathing

13 Aspirin for heart attack prevention (continued) Buffered aspirin dexamethasone, Taking aspirin with steroids may of OTC medicine: (Bufferin To avoid an upset stomach, take with food ) methylprednisolone, increase the risk of stomach prednisone upset, bleeding or ulcers. or milk. Enteric coated aspirin (Ecotrin ) from previous page ranitidine Taking ranitidine with aspirin may decrease the heart protection effects of the aspirin. Check with your doctor before taking together. Enteric coated aspirin (which has a special coating) may reduce the risk of a stomach ulcer or bleed. Do not crush, chew or break enteric coated tablets. Check with your doctor before starting aspirin therapy if you have an allergy to aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen or ibuprofen. Call your doctor immediately if you experience: blood in your stool, vomit, or urine severe stomach pains trouble breathing Aspirin

14 Cough Suppressant Cough suppressant for a dry, non-productive cough dextromethorphan fluoxetine, of OTC medicine: (Delsym ) paroxetine Dextromethorphan may cause dizziness, drowsiness or weakness. Zyvox Grapefruit products Haldol The use of these medicines together may increase the risk of side effects such as blurred vision, nausea, vomiting, high blood pressure, fever, nervousness, confusion and tremors. Check with your doctor before taking together. If taken together, monitor for side effects. Taking grapefruit products while taking dextromethorphan may increase the risk of side effects such as dizziness, drowsiness and fatigue. It is not recommended to consume grapefruit with dextromethorphan. The use of these medicines together may increase the risk of side effects such as confusion, trouble breathing, nervousness and tremors. Check with your doctor before taking together. If taken together, monitor for side effects. The use of a monoamine oxidase inhibitor (MAOI) (such as Nardil, Parnate or selegiline) with dextromethorphan may cause severe confusion, headache, fever or high blood pressure. The use of MAOIs and dextromethorphan should be avoided. Do not use dextromethorphan within 14 days of taking MAOI.

15 Iron supplementation for iron deficiency ferrous fumarate dairy products Dairy products may decrease the of OTC medicine: (Ferro-sequels ) effect of iron. It is recommended For best effect take iron on an empty not to take iron with dairy products. stomach, 1 hour before or 2 hours after a ferrous gluconate meal. If stomach upset occurs, iron may (Fergon ) carbidopa/levodopa be taken with food. ferrous sulfate (Feosol ) doxycycline, Levaquin, minocycline, tetracycline Levoxyl Iron may decrease the effectiveness of carbidopa/levodopa. Check with your doctor before taking together. Higher doses of carbidopa/levodopa may be needed for the best effect. The effects of these medicines may be decreased if taken with iron. Check with your doctor or pharmacist to find out when you should take these medicines. Take iron with a full glass of water. Iron may darken the color of your stool. Always check with your doctor before starting an iron supplement to be sure you are taking the appropriate dose. Prilosec Prilosec may decrease the effect of iron. Check with your doctor before taking together. Your doctor may have to monitor your iron levels more closely and increase your iron dose for the best effect. Iron

16 Laxatives Laxatives for relief of occasional constipation digoxin of OTC medicine: Ask your doctor before using laxatives if you have: senna (Senokot, ex-lax ) The use of these medicines together may increase the risk of digoxin side effects such as nausea, vomiting, vision changes (such as halos around lights) and confusion. Check with your doctor before taking together. If used together you should monitor for side effects and report side effects to your doctor. abdominal pain appendicitis bowel obstruction Crohn s disease nausea, vomiting These medicines are intended for short term relief of constipation and should not be used for more than 7 days without consulting with your doctor. Prolonged use may lead to laxative dependency. Excessive use may alter your sodium and potassium levels.

17 Nasal decongestants for stuffy head and stuffy nose of OTC medicine: phenylephrine amitriptyline, Nasal decongestants may temporarily (Sudafed PE ) desipramine, cause sleeplessness, nervousness and restlessness. To prevent having trouble falling doxepin, imipramine, asleep, take your last dose at least a few nortriptyline hours before bedtime. pseudoephedrine (Sudafed ) propranolol Zyvox When these medicines are taken together there may be an increased risk of developing high blood pressure, rapid heart rate and irregular heartbeat. It is recommended to avoid taking phenylephrine if you are taking these antidepressants. The use of these medicines together may increase the risk of high blood pressure, so check with your doctor before using them together. If taken together, monitor your blood pressure. The use of these medicines together may cause an increase in blood pressure in people who don t normally have high blood pressure. It is recommended to avoid using pseudoephedrine and Zyvox together. Nasal decongestants may also raise blood sugar and blood pressure or cause heart palpitations. If you are currently taking medicine for high blood pressure or high blood sugar, check with your doctor before taking nasal decongestants. The use of nasal decongestants with a monoamine oxidase inhibitor (MAOI) such as Nardil, Parnate or selegiline is not recommended. Avoid using together with, or within 14 days of, taking MAOI. Nasal Decongestants

18 Non-aspirin pain relievers Non-aspirin pain relievers for fever, headache and/or generalized pain of OTC medicine: acetaminophen carbamazepine, May increase the risk of liver damage Check with your doctor before using (Tylenol ) Dilantin if these medicines are taken with acetaminophen or acetaminophen higher doses of acetaminophen containing products if you have liver (greater than 1,300 mg per day) for problems. more than a few days. Do not exceed the recommended acetaminophen maximum dose of 4,000 mg per day. Higher doses may increase the risk of liver damage. warfarin Although acetaminophen is the recommended pain reliever while on warfarin, it is best to limit intake of large amounts and prolonged use. Taking warfarin with more than 2,000 mg of acetaminophen per day for more than a few days may increase the risk of bleeding. Additional PT/INR blood tests may be required. Check with your doctor before using acetaminophen if you have more than 3 alcoholic drinks per day on a regular basis. Alcohol may increase your risk of liver damage when taken with acetaminophen.

19 Nonsteroidal anti-inflammatory drugs (NSAIDs) for headache, arthritis and/or generalized pain OTC Medicine ibuprofen (Advil ) Interacts with Blood pressure Effects of Interactions When NSAIDs are used together with Safety tips/ possible side effects of OTC medicine: Check with your doctor before using medicines or these medicines, there may be a naproxen (Aleve ) NSAIDs if you have: diuretics (fluid pills) decrease in the effects of blood pressure anemia continued on next page medicines, and an increase in blood asthma pressure. If medicines are used together, aspirin allergy monitor your blood pressure closely. bleeding disorders citalopram, fluoxetine, When NSAIDs are taken together with heart failure paroxetine, these medicines there may be an high blood pressure sertraline increased risk of bleeding. Call your fluid retention doctor immediately if you have signs of ginkgo biloba kidney disease bleeding such as dark stools, bloody recent coronary artery bypass graft Lovenox, Plavix, vomit, nose bleeds or unexplained surgery (CABG) warfarin bruising. ulcers or stomach bleeding cyclosporine Dilantin lithium tacrolimus glyburide, glipizide NSAIDs NSAIDs may increase the side effects and blood levels of these medicines. Close monitoring of side effects and blood levels may be required. NSAIDs may increase the effects of these medicines and may cause hypoglycemia (low blood sugar). Close monitoring of blood sugar is recommended. It is best if you take NSAIDs with food. Tell your doctor if you experience the following symptoms while taking NSAIDs: bloody vomit or dark stools stomach pain swelling of the feet

20 NSAIDs Nonsteroidal anti-inflammatory drugs (NSAIDs) for headache, arthritis and/or generalized pain (continued) of OTC medicine: ibuprofen (Advil ) ketorolac The use of NSAIDs with keterolac is Check with your doctor before using not recommended because of the naproxen (Aleve ) NSAIDs if you have: increased risk of stomach bleed or from previous page ulcers. Talk to your doctor about use anemia of a different pain medicine. asthma aspirin allergy bleeding disorders heart failure high blood pressure fluid retention kidney disease recent coronary artery bypass graft surgery (CABG) ulcers or stomach bleeding It is best if you take NSAIDs with food. Tell your doctor if you experience the following symptoms while taking NSAIDs: bloody vomit or dark stools stomach pain swelling of the feet cc2193_otc 12_08

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