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2017 HCHB_digital

OTC Medicines:

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

OTC Medicines: Precautions Drug/drug group Condition Details Influenza vaccine Acute illness Postpone vaccination Iron Gastrointestinal diseases, eg, inflammatory bowel disease, Use only under medical advice diverticulae Iron storage/iron absorption diseases, eg, Use only under medical advice haemochromatosis Repeated blood transfusions, anaemia without iron Do not give iron deficiency Laxatives Abusers Electrolyte disturbances, especially potassium loss, diarrhoea. Excessive weight loss Acute abdominal conditions, undiagnosed abdominal pain Possible complications if laxatives used (eg, possible appendicitis) Colonic atony, immobile patients, insufficient fluid/ Bulk-forming laxatives may cause intestinal obstruction or faecal impaction dehydration Dehydration (severe) Further dehydration and electrolyte imbalance with stimulant laxatives Diabetes Can affect blood sugars in poorly controlled diabetes Difficulty swallowing Avoid bulk-forming laxatives Faecal impaction or obstruction Avoid oral laxatives, risk of colonic perforation Galactose or lactose intolerance Lactulose contains galactose and lactose. Avoid Haemorrhoids, anal fissures, proctitis Avoid laxative suppositories Inflammatory bowel disease Increased adverse effects with stimulant laxatives Regular use Avoid regular use of stimulant laxatives due to changes in rectal epithelium and risk of atonic colon Levonorgestrel Breast cancer Relative contraindication (but levonorgestrel less risk than pregnancy) Severe malabsorption syndrome, eg, Crohn's disease Impaired efficacy of levonorgestrel; increased dose may be required Severe liver disease Interferes with metabolism of levonorgestrel Meningococcal vaccine Acute illness Postpone vaccination Methyl salicylate Extensive topical application, exercise, heat occlusion Increased absorption of salicyclic acid into bloodstream (can be toxic) Metoclopramide Children, young patients and elderly Increased risk of extrapyramidal reactions. Use lower dosages especially if

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