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2017 HCHB_digital

OTC Medicines:

OTC Medicines: Interactions OTC Medicines: Interactions Drug/drug group Interacting substance Details Sympathomimetics Cardiac glycosides, quinidine, tricyclic Possible increased risk of arrhythmias (rare reports) (eg, phenylephrine – note antidepressants also systemic absorption Ergotamine or related compounds Additive vasopressor effects. Combination not recommended of nasal and ocular MAOIs – irreversible (eg, phenelzine, Significant risk of hypertensive crisis (up to 2 weeks after stopping MAOI). Avoid combination (includes all sympathomimetics may be tranylcypromine) oral, nasal and ocular products with pseudoephedrine or phenylephedrine) significant) MAOIs – reversible (eg, moclobemide) Possible increase risk of hypertension. Best avoided Methyldopa Isolated report of hypertension. Monitor blood pressure Other sympathomimetics Additive effects, increased toxicity Selegiline Increased risk of hypertension with higher dosages Tricyclic antidepressants May enhance the pressor response causing hypertension, headache, or tremor Trimethoprim Cyclosporin Reversible deterioration of renal function observed if combination used following renal transplantation Digoxin May increase plasma levels of digoxin in elderly people Diuretics - amiloride Excessively low serum sodium levels seen. May theorectically cause hyperkalaemia. Monitor electrolytes Methotrexate Consider folate supplementation if combination used Phenytoin May prolong half-life. Watch for phenytoin toxicity. Monitor Warfarin May potentiate anticoagulant activity of warfarin. Monitor Urinary alkalinisers Aspirin Increased clearance of salicyclates, possible reduced levels Flecainide Alkalinisation of the urine reduces the renal excretion of flecainide. Risk of flecainide toxicity increased. Monitor Fluroquinolones (eg, ciprofloxacin, May decrease the solubility of fluoroquinolones in the urine and increase the risk of crystalluria norfloxacin) Hexamine Requires urinary pH of 5.5 or lower to be active so alkalinisation of urine reduces antibacterial effect. Avoid Laxatives Additive laxative effect possible Lithium Often contain substantial amounts of sodium, which increases the urinary excretion of lithium, reducing plasma lithium levels. Avoid if possible or monitor Methadone Alkalinisation of the urine reduces clearance of methadone. Increased risk of toxicity Methotrexate Alkalinisation of the urine increases renal clearance of methotrexate. Therapeutic efficacy of methotrexate may be reduced Mexiletine Possibly reduced clearance of mexiletine REFERENCE SOURCES FOR TABLE MIMS online www.mims.co.nz/MIMSGATEWAY.aspx Medsafe data sheets www.medsafe.govt.nz Page 190 HEALTHCARE HANDBOOK 2017-2018 References Charts

OTC Medicines: Precautions Please note this list is NOT ALL INCLUSIVE. Only the more commonly reported or important precautions and contraindications are included. When selling any OTC medicine, consider the patient as a whole, including comorbid conditions, general health, age and frailty and weigh up risks versus benefits. Always use caution when selling medications to pregnant or breastfeeding women and check most recent literature sources. OTC Medicines: Precautions Drug/drug group Condition Details Analgesics – aspirin (usually less important with low-dose aspirin, eg, 75–100mg) Analgesics – NSAIDs Allergy including rash, anaphylaxis, Allergic symptoms, cross-sensitivity with NSAIDs rhinitis or asthma from aspirin, other NSAIDs or food dyes Asthma Asthma attack/worsening of asthma, rhinitis or sinusitis in asthmatics (occurs in 3-5% of population and up to 20% of asthmatics) Cardiovascular disease Sodium and water retention Children/adolescents with viral illness Reye's syndrome risk. Do not use in children aged less than 16 years with a viral illness Dehydration Risk of renal failure Elderly Increased risk of adverse effects Gastric irritation (indigestion, reflux, nausea, vomiting) Aggravates pre-existing symptoms Gastric ulcer Risk of bleed. Avoid in active gastric ulcer. Caution, preferably avoid, in history of gastric ulcer Gout Increases serum uric acid concentrations G6PD deficiency High doses can precipitate haemolytic anaemia Haemorrhagic disorders Increased risk of bleeding Hearing difficulties Analgesic/anti-inflammatory doses may aggravate and/or cause tinnitus Hepatic impairment Avoid in severe hepatic impairment High blood pressure Sodium and water retention History of asthma, rhinitis, atopy, nasal polyps Increased risk of allergy to aspirin and exacerbation of existing asthma, rhinitis, atopy or nasal polyps Infection May mask fever and inflammation Renal impairment Sodium and water retention, worsening of renal impairment Surgery or dental work (1 week prior, or just after) Prolongs bleeding Allergy including rash, anaphylaxis, rhinitis or asthma from Allergic symptoms, cross-sensitivity with NSAIDs aspirin or NSAIDs Asthma Asthma attack/worsening of asthma, rhinitis or sinusitis in asthmatics (occurs in 3–5% of population and up to 20% of asthmatics) Cardiovascular disease Sodium and water retention, increased blood pressure Dehydration Risk of renal failure Elderly Increased risk of adverse effects Gastric irritation Aggravates pre-existing symptoms Gastric ulcer Risk of bleed. Avoid in active gastric ulcer. Caution, preferably avoid, in history of gastric ulcer Haemorrhagic disorders Increased risk of bleeding Hepatic impairment Avoid in severe hepatic impairment High blood pressure Sodium and water retention History of asthma, rhinitis, atopy, nasal polyps Increased risk of allergy to aspirin and exacerbation of existing asthma, rhinitis, atopy or nasal polyps Infection May mask fever and inflammation Renal impairment Sodium and water retention Analgesics – paracetamol Alcohol dependence Use with caution. Avoid high or prolonged dosing Renal or hepatic impairment Use with caution. Avoid high or prolonged dosing Antacids Calcium kidney stones (or history of) Avoid calcium containing antacids Constipation Aluminium hydroxide can exacerbate Low phosphate diets (aluminium hydroxide) Phosphate depletion, increased bone resorption, hypercalciuria, risk of osteomalacia Low sodium diet, eg, heart failure, hypertension, renal failure, cirrhosis Porphyria Renal impairment Consider sodium content (sodium bicarbonate, sodium alginate). Preferably avoid sodium-containing antacids Avoid aluminium hydroxide Possible accumulation of some elements, eg, magnesium, aluminium, calcium Page 191

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