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OTC Medicines: Precautions<br />
OTC Medicines: Precautions<br />
Drug/drug group Condition Details<br />
Antidiarrhoeals Abdominal distension Avoid antidiarrhoeals<br />
Acute inflammatory bowel disease, ileus development, when May cause intestinal obstruction or toxic megacolon<br />
inhibition of peristalsis is to be avoided<br />
Antibiotic-associated pseudomembranous colitis<br />
Avoid antidiarrhoeals<br />
Diarrhoea associated with enterotoxin producing bacteria Avoid antidiarrhoeals<br />
Dysentery<br />
Do not use antidiarrhoeals alone<br />
Hepatic disease<br />
Increased levels loperamide<br />
Infants, young children<br />
Not generally recommended, have been associated with paralytic ileus<br />
Intestinal obstruction<br />
Avoid antidiarrhoeals<br />
Antifungals (eg, fluconazole) Impaired renal function Caution<br />
Previous liver disease with fluconazole, existing liver disease/ Liver disease may occur (fluconazole). Avoid miconazole oral gel<br />
dysfunction in hepatic impairment<br />
Potentially proarrhythmic conditions<br />
Rare cases of QT prolongation and torsade de pointes with fluconazole<br />
Antihistamines – sedating Broken skin<br />
Avoid topical antihistamines<br />
(eg, promethazine,<br />
Epilepsy<br />
Occasional reports of convulsions<br />
brompheniramine,<br />
azatadine, chlorpheniramine,<br />
Hepatic impairment<br />
Caution advised. Dose reduction may be necessary<br />
diphenydramine, triprolidine, Narrow angle glaucoma, prostate problems, constipation, Anticholinergic effects may aggravate these conditions<br />
cyclizine, dimenhydrinate,<br />
meclozine)<br />
urinary retention<br />
Porphyria<br />
Possible acute attacks of porphyria with some antihistamines (eg, diphenhydramine,<br />
promethazine)<br />
Productive cough<br />
Thickens respiratory tract secretions<br />
Renal impairment<br />
Dose reduction may be needed<br />
Significant renal impairment<br />
Increased levocabastine blood levels likely after nasal usage<br />
The very old, the very young<br />
Increased risk of side effects, including paradoxical stimulation. Avoid in young<br />
children<br />
Antihistamines –<br />
Hepatic or renal impairment<br />
Possible accumulation of drug, may need dose reduction<br />
non-sedating<br />
Antimuscarinics<br />
Children, elderly<br />
Increased risk of side effects<br />
(eg, scopolamine, hyoscine butyl Epilepsy<br />
Seizures possible (rare)<br />
bromide)<br />
Impaired metabolism, liver or kidney function<br />
Increased CNS effects (scopolamine)<br />
Narrow angle glaucoma, prostate hypertrophy, constipation, Antimuscarinic effects aggravate these conditions<br />
urinary retention<br />
Porphyria (hyoscine butylbromide)<br />
Association with acute attacks of porphyria<br />
Antitussives<br />
Abuse<br />
Codeine or dextromethorphan abuse has been reported<br />
(eg, codeine, pholcodine,<br />
Asthma<br />
Avoid in acute attack, caution if history of asthma<br />
dextromethorphan)<br />
Children<br />
Caution, avoid in infants<br />
Constipation<br />
Codeine mainly (opiate effects slow GIT motility)<br />
Risk of respiratory failure<br />
Increased risk of respiratory failure<br />
Bromhexine Asthma Care advised with bromhexine<br />
History of peptic ulcer disease<br />
May disrupt the gastric mucosal barrier<br />
Severe hepatic or renal impairment<br />
Reduced clearance bromhexine or metabolites<br />
Chloramphenicol (ocular) Blurred vision, eye pain, or photophobia Refer to the doctor or TPA-endorsed optometrist<br />
Contact lens wearers<br />
Refer to the doctor or TPA-endorsed optometrist<br />
Unsure of diagnosis<br />
Refer to the doctor or TPA-endorsed optometrist<br />
Diptheria/ tetanus/ Acute illness<br />
Postpone vaccination<br />
pertussis (Tdap)<br />
Prior reaction to Tdap<br />
Dependant on reaction. Refer to doctor<br />
Dukoral Acute illness Postpone vaccination<br />
Ear wax softeners Inflamed ear/perforated ear drum Avoid use<br />
Head lice products Skin disease Caution with some treatments<br />
Young children<br />
Caution with most chemical treatments<br />
H2 antagonists Renal impairment Reduce dose<br />
Porphyria<br />
Avoid<br />
Iodine supplements (oral) Excessive use Higher intakes than recommended can cause adverse effects such as thyroid problems<br />
Thyroid disorders (eg, hypothyroidism, goitre, thyroid<br />
tumours)<br />
Can worsen these conditions<br />
Page 192 HEALTHCARE HANDBOOK <strong>2017</strong>-2018 References Charts
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