OTC Medicines: Precautions OTC Medicines: Precautions Drug/drug group Condition Details Orlistat Chronic malabsorption syndrome Avoid Cholestasis (reduced/halted bile flow) High fat intake History of calcium oxalate kidney stones Type 2 diabetes Avoid Increased risk of adverse GI effects Caution May need hypoglycaemic dose adjusted Oseltamivir Renal impairment Moderate renal impairment reduce dose, avoid in severe renal impairment Povidone iodine (see also Severe burns/extensive areas Increased sytemic effects iodine – avoid iodine supplements [oral]) Thyroid disorders Regular or prolonged use may aggravate thyroid disorders Prochlorperazine Dehydration Hypotension Elderly, debilitated Increased risk of side effects Impaired kidney, cardiovascular, cerebrovascular, Increased risk of side effects, avoid respiratory function Narrow angle glaucoma, parkinsonism, paralytic ileus, Contraindicated urinary retention, prostatic hypertrophy, epilepsy, blood dyscrasias, impaired liver, myasthenia gravis Phaeochromocytoma Hypertensive crisis Sildenafil Diabetes, smokers, self-reported high cholesterol, previous Refer to doctor coronary intervention, cardiovascular disease, unusually high or low blood pressure Under 35 years and over 70 years Refer to dcotor Sumatriptan, zolmitriptan Heart disease or symptoms of heart disease, peripheral Do not use – sumatriptan causes vasoconstriction vascular disease, history of heart attack, stroke or transient ischaemic attack (TIA) Hemiplegic, basilar or ophthalmoplegic migraine Avoid History of seizures or conditions predisposing to seizures Seizures have occurred in some patients with history or predisposing factors Hypertension, including controlled hypertension Transient increases in blood pressure and peripheral vascular resistance sometimes occur – do not use OTC Increased risk of heart disease Refer to doctor No previous history of migraine OTC sumatriptan not allowed Prinzmetal’s angina (pain at rest rather than during Avoid activity) Renal or hepatic disease Avoid OTC use Sulphonamide allergy Possible cross-sensitivity (sumatriptan only) Unclear migraine diagnosis Use only with a clear migraine diagnosis Under 18 years or over 65 years OTC sumatriptan or zolmitriptan not indicated Sympathomimetics Cardiovascular disease, high blood pressure May increases heart rate and blood pressure (eg, phenylephrine – note also Diabetes (poorly controlled) May alter blood glucose control systematic absorption of nasal Hyperthyroidism Possible additive tachycardia and ocular sympathomimetics may be significant) Infants and young children Increased risk Narrow angle glaucoma Aggravated by sympathomimetics Renal impairment Caution advised Trimethoprim Antibiotic use (within 6 months) Avoid Pregnancy Avoid in first trimester of pregnancy (folate antagonist) Renal impairment or abnormality, catheterisation, history of renal stones etc Refer to a doctor Page 194 HEALTHCARE HANDBOOK 2017-2018 References Charts
OTC Medicines: Adverse Effects Commonly reported adverse effects that do not require laboratory tests to detect are listed below. These tables are not ALL INCLUSIVE and do not list medicines or supplements know to cause renal or hepatic impairment or blood dyscrasias. OTC Medicines: Adverse Effects Adverse effect Anorexia Anxiety Asthma (exacerbation of) Black stools Constipation Dependence Diarrhoea Dizziness Dry eyes Dry mouth Fever Flushing Gastric Irritation Caused by Diptheria/ tetanus/ pertussis (Tdap) Possibly phenylephrine Aspirin and salicylates Benzoates, Sulphites (preservatives) NSAIDs Propolis, Royal jelly Tartrazine (colouring agent) Iron Aluminium hydroxide (in antacids) Antihistamines (sedating only) Bulk-forming laxatives (if taken with too little fluid, or in people with dehydration) Calcium (supplements or in antacids) Codeine (decreases gut motility) Iron salts Laxatives (overuse, abuse) Omeprazole, lansoprazole Codeine Nicotine nasal spray, nicotine gum Oxymetazoline, xylometazoline (overuse of nasal products) Stimulant laxatives (eg, prolonged use of sennosides) Aloes Cascara Fluconazole H2 antagonists Iron salts Isphaghula Laxatives (overuse or abuse) Magnesium (supplements or in antacids) NSAIDs Omeprazole Orlistat Psyllium husk (bulk-forming laxative) Senna Oseltamivir Sumatriptan Antihistamines (sedating only) Prochlorperazine Scopolamine Antihistamines (sedating) Hyoscine Prochlorperazine Phenylephrine Diptheria/ tetanus/ pertussis (Tdap) Influenza vaccine Meningococcal vaccine Sildenafil Sumatriptan Aspirin Bromhexine Bulk-forming laxatives (flatulence, bloating) OTC Medicines: Adverse Effects Adverse effect Gastric irritation Cont… Headache Increased bleeding Caused by Caffeine Calcium (flatulence) Diptheria/ tetanus/ pertussis (Tdap) Dukoral (GI upset and rarely cramping) Eucalyptus Fish oils Fluconazole (abdominal pain, flatulence, nausea, vomiting) Garlic Iodine (oral) Iron salts Lactulose (cramps, flatulence) Levonorgestrel (nausea) Loperamide Magnesium, Potassium, Zinc salts Mebendazole Meningococcal vaccine NSAIDs Omeprazole Orlistat (flatulence, faecal urgency, fatty stools, discharge) Oseltamivir (nausea, vomiting, abdominal pain) Parsley Pyrantel Sildenafil Sodium bicarbonate (stomach cramps) Squill Stimulant laxatives (colic, cramps) Sumatriptan (nausea, vomiting) Turmeric Antihistamines (sedating) Analgesics (overuse) Black cohosh Diptheria/ tetanus/ pertussis (Tdap) Fluconazole Influenza vaccine Levocabastine eye drops and nose spray Meningococcal vaccine Nicotine replacement NSAIDs (including overuse) Omeprazole Oseltamivir Sildenafil Aspirin Bilberry Bromelain Clove Coleus Docosahexaenoic acid (DHA) Dong quai Feverfew Fish oils Garlic Ginger Ginkgo Page 195
According to Stéphane Rossini, incoming Chairman of the Agency Council, the culture of collaboration will remain a factor in ensuring that Switzerland is successful in retaining a high-quality medicines control system: “A globalised economy and the international consumption of therapeutic products entail synergies and collaboration.”
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