Nonprescription Medication Guidelines
for Transplant Patients
About Nonprescription Medications
medicines do not require a doctor’s
prescription for purchase, but they do have
real effects and should be used with caution.
This is true for patients who have received a
transplant. This handout contains
information to help you safely get the
greatest benefit from OTC medicines. It
will provide recommendations about which
OTC medicines have the fewest interactions
or side effects.
If any of the information in this handout
causes you special concern or if you want
more information about your medicine and
its use, check with your doctor, nurse or
Remember to keep all medicines out of
the reach of children. Never share your
medicines with others.
Before Choosing an OTC Medicine
Tell your doctor, nurse, and pharmacist if
ξ Are allergic to any medicine, either
prescription or nonprescription (OTC).
ξ Are pregnant or intend to become
pregnant while using this medicine.
ξ Are breast-feeding.
ξ Are taking any other prescription or
nonprescription (OTC) medicine or
ξ Have any other medical problems,
Proper Use of OTC Medicines
Take OTC medicines only as long as
recommended on the package directions or
as directed by your doctor. Do not take
more of it and do not take it more often or
for a longer period of time than directed.
OTC products help relieve symptoms, but
are not cures. If your symptoms do not
improve in 2 or 3 days, begin to worsen, or
if you have a fever or chills, contact your
Recommended OTC Medicines
Headache, Fever, and Body Aches
Acetaminophen (Tylenol ) can help relieve
mild pain and fever. The maximum daily
dose of acetaminophen is 4000 mg. If you
have had a liver transplant, the dose should
not exceed 2000 mg per day for 3 days in a
row. Higher doses can harm your liver.
Many products may contain acetaminophen;
check labels for the amount in each.
Do not take nonsteroidal anti-inflammatory
drugs (NSAIDs) because they can harm your
kidney or interact with certain
immunosuppressants. Common NSAIDs
are: ibuprofen (Advil , Motrin , Midol
Cramp Formula), naproxen (Aleve ) and
ketoprofen (Orudis KT ). Also avoid taking
aspirin unless your doctor prescribed it.
Aspirin is in some combination pain
relievers, such as Excedrin or Bayer .
Sneezing, Itching and Runny Nose
Antihistamines are effective and, as a rule,
safe to use. Loratadine (Claritin ) and
cetirizine (Zyrtec ) are preferred because
they cause the least drowsiness. Cromolyn
(NasalCrom ) is another option to prevent
allergy symptoms. It works best if you
begin using it at least 1 week before you are
in contact with possible allergens.
Diphenhydramine (Benadryl ) and
chlorpheniramine (Chlor-trimeton ) are
other options, but are best used at bedtime
because they cause more drowsiness. Talk
to your doctor before using an antihistamine
if you have glaucoma, an enlarged prostate
or trouble urinating.
Avoid combination (multi-symptom) cold,
sinus, and flu products (TheraFlu ,
Nyquil ). It is better to treat each symptom
alone. Accidental overdoses sometimes
occur when patients duplicate therapy. If
one of these products cannot be avoided,
make sure to read the label carefully and get
the advice of your doctor or pharmacist.
Nasal and Sinus Congestion
Topical nasal sprays are the most helpful for
congestion. Topical decongestants such as
oxymetazoline (Afrin ) and phenylephrine
(Neosynephrine ) should not be used for
more than three days because longer use can
cause more congestion. Sodium chloride
9.9% (Ocean spray) can be used safely
long-term to keep nasal passages moist.
SinuCleanse is another product that
relieves allergies, nasal congestion, and
inflammation of the sinuses. It is a saline
solution that can be used as a nasal washing
through various devices or bottles.
Oral decongestants, such as
pseudoephedrine (Sudafed ) and
phenylephrine (Sudafed PE ) should be
used with care because they can raise your
blood pressure. Make sure to check the list
of active ingredients as pseudoephedrine and
phenylephrine can be found in various
cough and cold products.
Most throat lozenges can be used safely. If
you have diabetes, look for sugar-free
products. Follow the label’s dosing
Guaifenesin (Robitussin ) is recommended
for chest congestion. Coricidin HBP Chest
Congestion & Cough is another option that
can make the cough more productive. Make
sure to drink plenty of water to help loosen
Guaifenesin (Robitussin ) is also
recommended for a cough with loose
secretions. For a dry cough, the cough
suppressant dextromethorphan (Delsym ) or
a guaifenesin/DM combination (Robitussin
DM ) can be used. Coricidin HBP Chest
Congestion & Cough can be used safely in
patients with high blood pressure. Vicks
VapoRub ointment and Vicks VapoSteam
are different types of products that can
relieve a cough for a time. If you have
diabetes, look for a product free of sugar and
alcohol. Use other Coricidin HBP
products, such as Cold & Flu and Maximum
Strength Flu with care as they contain
regular or extra-strength acetaminophen
Loperamide (Imodium AD ) can be used for
short-term treatment of diarrhea. It should
not be used for longer than 48 hours. Pepto-
Bismol and Kaopectate should be avoided
because they may decrease the absorption of
some immunosuppressive drugs. If your
diarrhea is caused by an infection, you
should not treat it with OTC products. If
your diarrhea is heavy, bloody, or lasts for
more than a day you should get medical
Recommended products include bulk-
forming products (Metamucil , Fiberall );
stool softeners, such as docusate (Colace );
and stimulants, such as bisacodyl
(Dulcolax ), senna, or milk of magnesia
(Phillip’s ); hyperosmotics, such as
polyethylene glycol (MiraLAX ); and
combinations of a stool softener with a
stimulant such as docusate with senna
(Senokot-S ). Long-term use of stimulant
laxatives should be avoided because they
may result in long-term diarrhea and
changes in your electrolytes. If you remain
constipated for more than 48 hours, please
contact your doctor.
Stomach upset can be treated with calcium
carbonate (TUMS ), ranitidine (Zantac );
famotidine (Pepcid AC ), nizatidine (Axid
AR ) or omeprazole (Prilosec OTC ). Be
careful not to take TUMS or magnesium-
containing products at the same time as
some immunosuppressants such as
mycophenolate (Cellcept or Myfortic ),
tacrolimus (Prograf ) or sirolimus
(Rapamune ). Take the OTC products at
least 1 hour before or 2 hours after the
immunosuppressants. If you are having
loose stools, avoid products containing
magnesium such as Mylanta , Mygel ,
Maalox , and Riopan because they can
make diarrhea worse. They may also cause
your magnesium levels to get too high if
your kidneys are not working properly.
Avoid cimetidine (Tagamet ) because it has
many drug interactions.
Simethicone (Gas-X ) is recommended for
gas symptoms. If you have diabetes, you
should avoid using Beano . The safety of
Beano in patients with diabetes has not
been studied. Beano is used to prevent, not
treat, gas symptoms.
Diphenhydramine (Benadryl ) and
doxylamine (Unisom ) can be used
occasionally to help you fall asleep. They
should be used with care if at all in patients
with glaucoma, enlarged prostate, or trouble
Dry Eyes and Eye Irritation
Artificial tears eye drops are recommended
for the symptoms of dry eyes and eye
irritation. Ketotifen (Zadiator ) eye drops
are another option to prevent eye irritation
for 8-12 hours. They should not be used for
contact lens-associated irritation.
Nausea and Vomiting
Meclizine (Antivert ) can be used to treat
and prevent symptoms of nausea and
vomiting. Please tell your doctor before
taking this medicine as your other medicines
may have similar side-effects which could
make you drowsier.
Capsaicin cream (Capzasin-P ) can be used
as a topical pain reliever. It provides
temporary relief of muscle, joint pain, and
back pain by desensitizing an area to pain.
The cream may cause an uncomfortable
burning sensation in the area since the main
ingredient comes from chili peppers. Wear
gloves while applying capsaicin cream.
Skin Irritation, Insect Bites and Poison
Topical corticosteroids, such as
hydrocortisone cream (Cortisone-10 ), are
highly recommended for the treatment of
skin irritation, insect bites, and poison ivy.
Use of corticosteroids should be short term.
If the condition worsens or if the symptoms
persist for more than 7 days, stop using the
medicine and consult your doctor.
Precautions While Using OTC Products
CHECK THE LABELS OF ALL
NONPRESCRIPTION AND PRESCRIPTION
MEDICINES YOU NOW TAKE. Many OTC
medicines sold for different uses have the
same active ingredients. If you are taking
multiple medicines, read labels carefully to
lessen the risks of an accidental overdose.
Many drugs contain sweeteners. Patients
with diabetes should look for sugar-free
products. In the ingredient list sugar may
appear as sugar, honey, dextrose, fructose,
high fructose corn syrup, lactose, sorbitol, or
mannitol. Calorie-free sweeteners include
aspartame, acesulfame potassium, and
Be careful not to take OTC products when
on prescription drugs of the same kind.
Avoid products that have high alcohol
content, such as Nyquil .
The use of herbal medicines is not
recommended. These products are not
regulated by the FDA and may contain
contaminants and impurities. Also, many
herbals have been shown to interact with
your immunosuppressive medicines.
Do not use phenazopyridine (Azo-
Standard ) to treat undiagnosed urinary tract
pain. This product treats painful symptoms
but not the source of the infection. Such use
could lead to serious delays in proper
diagnosis and treatment
Do not use callus, corn or wart removers.
Leave treatment of these problems and foot
infections to your doctor or podiatrist.
Possible Side Effects of OTC Medicine
Possible side effects for nonprescription
medicines are listed on the instruction sheet
that comes with the product.
Ellington T, Wipke-Tevis D, Messina C, Livesay T.
The use of over-the-counter medication by transplant
recipients: a guideline. J Transplant Coordination.
Raglin Quartetti H. FAQs on OTCs. Diabetes
Roberts SS. 20 Questions. Diabetes Forecast.
Spanish Version of this HFFY #6520
Reproduced, with permission, from the 1989-2009 United State Pharmacopeial Convention, Inc. Printed in 1/2016
by the University of Wisconsin Hospitals and Clinics Authority, Department of Nursing, Madison, WI. Reviewed
by Department of Pharmacy. UWH #6161
OTC Quick Guide
Headaches, fever & body aches Acetaminophen (Tylenol )
Sneezing, itching or runny nose Loratadine (Claritin ),
Cetirizine (Zyrtec ),
Cromolyn (NasalCrom )
Nasal & sinus congestion Nasal sprays:
Oxymetazoline (Afrin ),
Phenylephrine (Neosynephrine )
Sodium chloride (Ocean ), (SinuCleanse )
Pseudoephedrine (Sudafed )
Chest congestion Guaifenesin (Robitussin ),
Coricidin HBP Chest Congestion & Cough
Productive cough Guaifenesin (Robitussin )
Dry cough Dextromethorphan (Delsym )
Guaifenesin/Dextromethorphan (Robitussin DM )
Coricidin HBP Chest Congestion & Cough
Sore throat Lozenges
Constipation Psyllium (Metamucil ),
Docusate (Colace ),
Docusate with senna (Senokot-S ),
Bisacodyl (Dulcolax )
Polyethylene glycol (MiraLAX ),
Diarrhea Loperamide (Imodium AD )
Insomnia Diphenhydramine (Benadryl ),
Doxylamine (Unisom )
Stomach upset Calcium carbonate (TUMS )
Heartburn Ranitidine (Zantac )
Famotidine (Pepcid AC )
Nizatidine (Axid )
Omeprazole (Prilosec OTC )
Gas Simethicone (Gas-X )
Dry eyes and eye irritation Artificial Tears,
Ketotifen (Zadiator )
Nausea & vomiting Meclizine (Antivert )
Joint pain Capsaicin cream (Capzasin-P )
Skin irritation, insect bites, poison ivy Hydrocortisone (Cortisone-10 )
Common brand names are listed in parenthesis. Generic products are available for some
products, and may be used instead of the brand name product. Read labels carefully to make
sure you are getting the same active ingredient.