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2017 HCHB_digital

OTC Medicines: Adverse

OTC Medicines: Adverse Effects OTC Medicines: Adverse Effects Adverse effect Increased bleeding cont... Increased blood pressure Increased risk of blood clots Injection site reactions (pain, redness, swelling) Insomnia Irritability/ fatigue Local irritation Menstrual bleeding changes Metallic taste Mouth ulcers/irritation Nasal bleeds Nasal stuffiness Rebound acid secretion Sedation Caused by Ginseng Guggul Horse chestnut NSAIDs Turmeric Aspirin (possibly) Liquorice (large doses) NSAIDs Phenylephrine Sumatriptan (transient) Combined oral contraceptives (risk depends on dosage and specific hormone) All injectable vaccinations Caffeine Ginseng, guarana Nicotine Oseltamivir Sympathomimetics (eg, possibly phenylephrine) All injectable vaccinations Chloramphenicol Nasal or ocular antihistamines Nasal corticosteroids Nasal decongestants Nicotine, nasal spray, inhalation Povidone iodine Rectal bisacodyl Tea-tree oil (Melaleuca alternifolia) Oral contraceptives (amenorrhoea, breakthrough bleeding, short-cycles) Iodine (oral) Aspirin Feverfew Iodine (oral) Nicotine lozenges, gum Nasal corticosteroids Nasal nicotine Decongestant nasal drops and sprays (prolonged use) Sildenafil Calcium carbonate (after long-term use) Antihistamines (sedating) Azelastine nasal spray Chamomile Codeine Diptheria/ tetanus/ pertussis (Tdap) Hops Hyoscine butylbromide Kava L-5-HTP Levocabastine eye drops and nose spray Loperamide Metoclopramide Passionflower Pholcodine Prochlorperazine OTC Medicines: Adverse Effects Adverse effect Sedation cont... Skin reactions Stimulation Tachycardia (fast heart beat) or palpitations Teeth staining Urinary retention Caused by Scopolamine Skullcap Sumatriptan Valerian Aciclovir, penciclovir (transient stinging, burning) Aluminium chloride topical (irritation) Aniseed (furanocoumarins, photosensitivity, contact allergy) Antifungals (burning, irritation) Antihistamines (topical) Aspirin and salicylates (hypersensitivity reactions) Benzyl benzoate (irritation) Benzoyl peroxide (irritation) Bergamot oil (photosensitivity) Capsaicin (stinging, burning) Celery (photosensitivity) Chamomile (contact allergy) Cinnamon (contact allergy) Coal tar and derivatives (photosensitivity, irritant dermatitis) Dandelion (contact allergy) Dong quai (photosensitivity) Feverfew (hypersensitivity reactions) Garlic (sulphur allergy) Gotu kola (contact dermatitis) Head lice and scabies treatments Idoxuridine (irritation, hypersensitivity) Menthol (contact dermatitis) Nicotine transdermal patches (irritation, allergy) NSAIDs (hypersensitivity reactions) Omeprazole Paracetamol (rarely serious skin reactions) Povidone iodine (hypersensitivity, irritation) Promethazine (photosensitivity) St John’s wort (sensory nerve hypersensitivity) Salicylic acid (irritation) Tea-tree oil (allergic dermatitis) Trimethoprim (rash, pruritis, dermatitis) Wood tars (irritation) Sedating antihistamines (paradoxical) Caffeine Ginseng Nicotine replacement therapy Phenylephrine (possibly) Prochlorperazine Chlorhexidine Liquid iron (dilute with water and use straw) Tannin-rich agents (eg, green tea) Antihistamines (sedating only) Hyoscine Prochlorperazine Phenylephrine Scopolamine Page 196 HEALTHCARE HANDBOOK 2017-2018 References Charts

Herbal Supplements: Interactions POTENTIAL INTERACTIONS BETWEEN DRUGS AND PHYTOMEDICINES Herbal Supplements – Interactions Herb/herb group Possible interacting drugs Possible interaction(s) References Aloe vera gel and juice American ginseng (Panax quinqefolium) Andrographis (Andrographis paniculata) Oral hypoglycaemic drugs (eg, glibenclamide) Increased hypoglycaemic effects possible Vitamin C and E Increased absorption possible 1 Antipsychotics Possible potentiation of antipsychotic properties suggested Improvement in working memory & reduced extrapyramidal effects Oral hypoglycaemics Possible enhancement of hypoglycaemic effect 242 Warfarin Reduced plasma levels in healthy males after two weeks ginseng administration Cisplatin Potentiation of in vitro antitumour action by andrographolide 217 Etoricoxib Reduced etoricoxib bioavailability with large doses of Andrographis or 248 andrographolide reported in rats Nabumetone Reduced Cmax and AUC of nabumetone, and compromised its antiarthritic 257 activity in rats Naproxen Reduced oral bioavailability of naproxen in rats, but increased anti-arthritic 258 activity Theophylline Drug bioavailability reduced in studies on rats 216 Aniseed essential oil Paracetamol Reduced paracetamol bioavailability reported in mice 259 Anthraquinone laxatives Cisplatin Reduced anti-cancer activity implicated by in vitro study involving aloe emodin 2 Anxiolytics (eg, valerian, kava, passionflower, hops) Anti-platelet agents (eg, ginger, garlic, clove, feverfew) Digoxin and other cardioactive glycosides Potassium depletion (hypokalaemia) leading to increased risk of cardiac 3, 4 toxicity, if large doses used Thiazide diuretics Potassium depletion 3, 4 Hypnotics, tranquillisers, opiates and some analgesics acting as CNS depressants Anticoagulants (eg, warfarin, heparin) 223 243 Additive CNS depressant effects, particularly with large doses 5, 6 Potentiation of anticoagulant effect and bleeding theoretically possible with large doses Bacopa monnieri Thyroxine Possible potentiation of thyroid hormone effects 8 Baical skullcap (Scutellaria baicalensis) Cyclosporin Possible reduction in bioavailability of oral cyclosporin if co-administered with 9 large doses Baical skullcap Grape seed Potentiated antioxidant effects 10 Etoposide Possible potentiation of antitumour action, by wogonin 218 Mefenamic acid Potentiation of anti-inflammatory effects & reduction in gastric ulcer adverse 249 effects in rats Methotrexate Large doses increased methotrexate bioavailability in rats 260 Rosuvastatin Reduced plasma oncentrations of rosuvastatin possible 11 Barberry Antihypertensives Possible enhanced hypotensive effect, with large doses of fruit extract 12 (Berberis vulgaris) Berberis vulgaris Losartan Berberine increased Cmax and AUC of losartan in rats (inhibition of CYP3A4 261 proposed) Betel nut Antipsychotic drugs Increased parkinsonian side effects reported with flupenthixol and fluphenazine 13 (Areca catechu) Bilberry Warfarin Possible potentiation of anticoagulant activity, with high doses 14 Bitter melon (Momordica charantia) Blackseed (Nigella sativa) Bladderwrack (Fucus vesiculosus) Oral hypoglycaemic drugs Increased hypoglycaemic effects possible, if large doses taken 15, 16 Vinblastine Reversal of multidrug resistance reported in vitro 17 Amoxycillin Enhanced parenteral and oral bioavailability reported in rats 225 Ciprofloxacin Possibly reduces potential epileptogenic activity of ciprofloxacin 234 Amiodarone Reduced oral drug bioavailability reported in rats 224 Antithyroid agents (carbimazole, Possible antagonism of antithyroid hormone activity 18, 19 propylthiouracil, etc) Thyroxine Possible potentiation of thyroid hormone activity 18, 19 2 7 Page 197

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