Dr. Rx: Common OTC interactions to note
VCU School of Pharmacy faculty, alumni and students have provided the Dr. Rx column for Richmond’s Fifty Plus magazine since December 2009. We now share those columns on the SOP website, as well, for those who might not have seen the most recent issue.
Serving as Dr. Rx for July 2014 was Linda Barstow, a fourth-year Pharm.D. student who is interested in ambulatory care with a focus on older adults. She earned her bachelor’s degree in biology at University of Virginia.
Dear Dr. Rx: My whole life I have taken very few medications. Recently, I suffered a heart attack and was discharged on many medications. My doctor warned me that over-the-counter products can interact with all these new meds, but I have a medicine cabinet full of my favorite products! Which ones should I throw away, and which ones can I keep?
Going home after a hospitalization with a stack of prescriptions for unfamiliar medications is overwhelming. It can be a challenge that older adults often face. It is a great idea to plan now so that you have a safe OTC medication when you need it.
No standard list of heart attack medications is prescribed to every patient; unfortunately, OTC drug safety differs for each patient. It is important to ask a pharmacist about potential interactions whenever you purchase an OTC product. In the meantime, here are some commonly taken over-the-counter medications to which you might want to pay particular attention.
Analgesics/ Pain Control
The NSAIDS comprise a common class of OTC pain medications. Popular medications that fall into this class include Ibuprofen (Advil) and Naproxen (Aleve). Stronger NSAIDs can be prescribed for inflammatory disorders, such as arthritis. Although it is commonly prescribed for certain heart conditions rather than pain relief, aspirin also falls into the NSAIDs category.
After suffering a heart attack, patients often are given cardiovascular drugs designed to thin the blood, and these interact with NSAIDs. Warfarin (Coumadin) is an example. Taking OTC NSAIDs with this medication can cause the blood to thin excessively, which can increase the risk of harmful bleeding. A number of new blood thinners can be prescribed. If you are taking a medication for a previous cardiovascular event, it is important to use caution with OTC NSAIDs and to consider alternatives such as Acetaminophen (Tylenol) for minor aches and pains.
Cold/ Cough/ Flu Remedies
Pseudoephedrine (Sudafed) and phenylephrine (Sudafed PE) are decongestants you can obtain without a prescription. Although more widely recognized under the Sudafed brand name, these products are contained in numerous combination cough, cold, flu and even allergy remedies. It is important always to look at the ingredients and, as a general rule, to limit the amount of active ingredients in an OTC product so that you more effectively target your symptoms without suffering unwanted side effects.
Decongestants can be particularly dangerous because these products can raise your blood pressure. While safe for a patient with no cardiac history, a rise in blood pressure could be harmful if you have a history of heart attacks. Decongestants could also inhibit the action of some of your medications. Most pharmacies carry Coricidin products, which are formulated for people who have high blood pressure or who have experienced a cardiac event. These products are typically safer to have on hand if you need relief from cough, cold or flu symptoms.
Herbals/ Vitamins
There are simply too many vitamins and herbals to address every potentially harmful product, so it is extremely important that you review any OTC supplement you take with your doctor or pharmacist. One supplement class of particular importance is for weight loss. Following a hospitalization, patients are often motivated to begin a healthier lifestyle; however, weight loss supplements can be a dangerous avenue for achieving this goal.
Weight-loss supplements can interact with your medications and often raise your blood pressure in a similar way to decongestants. My advice is to avoid these products all together. But if you feel you would benefit from weight-loss supplement, always ask a health-care provider before purchasing.
Another supplement of concern is St John’s Wort. This product is promoted as a “cure all” for whole body health and promoted for uses from fighting cancer and soothing inflammation to helping with anxiety, tension and depression. It is very important to note that the FDA has not evaluated the validity of these assertions. The negative consequences of taking this product often outweigh the benefits.
One important side effect of St. John’s Wort that is not widely known by patients is that it causes many drugs to exit the body more quickly, resulting in reduced efficacy. This could lead to the various health complications your doctor is trying to prevent with all the new medications.
It is important that you have effective OTC products available for use when you need them. However, with more medications comes a greater risk of drug interactions and harmful side effects. The best way to find the most effective OTC product for your individual needs is to maintain a good relationship with your doctor and pharmacist and to play an active role in your own health by staying informed!
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