Over the Counter Medications

As patients with pre-existing conditions, who may be on a list of prescription medications, it’s important to know which over-the-counter (OTC) medications are safe for CHD patients  Recently at an Adult Congenital Heart Disease Conference, Justina Damiani, Inpatient Cardiology Pharmacist at Lurie Children’s, shared her recommendations for OTC meds, for those everyday illnesses or aches and pains.
*Please be sure to also consult your own doctor and pharmacist before starting or ending any medication.

General OTC Medication Tips

Always look at the active ingredient.
  –  Some brand name products may contain medications that are harmful.
  – Also, watch out for multi-ingredient preparations. Many cough/cold medications contain pseudoephedrine or phenylephrine which, are not recommended.
  – Avoid medications with a “D” at the end of the name.
Always check the appropriate dose
Always check the maximum daily dosage

 

 

OTC Cough and Cold Products

Pseudoephedrine:

Similar to phenylephrine, pseudoephedrine is also commonly used to treat nasal congestion. These products are stored behind the counter at your local pharmacy and require an ID for purchase. If pseudoephedrine is in a combination product it is usually identified as the “D,” for example Mucinex D ® or Claritin D®. The reason the we recommend to avoid use is that pseudoephedrine commonly causes increases in blood pressure, heart palpitations, increases in heart rate and potentially cardiac arrhythmias.

Phenylephrine:

Phenylephrine is commonly used to treat nasal congestion during the common cold. This can be purchased as a single ingredient product or in combination with other medications. If it is a combination product there is usually a “PE” on the label. While this is very effective in treating nasal congestion, it also can cause unsafe increases in blood pressure. Although rare, it can also worsen heart failure or induce cardiac arrhythmias.

 

Ibuprofen (Motrin)/Naproxen (Naprosyn):

Ibuprofen can be safe to use in certain people. Definitely talk to your provider if you are interested in using this for yourself, or your patient. Ibuprofen is often used for pain control and to treat fevers. This drug can be very helpful for both of those indications. The reason it can be considered unsafe is that it can hurt the kidneys. This is more of a concern in patients who already have underlying kidney issues.  This medication is commonly used in patients with cardiac disease unless you have baseline kidney issues or you were told to avoid it by your doctor.

 

 

Heart Safe Cold/Flu Products

 

Coricidin HBP (High Blood Pressure) is recommended for anyone greater than 12 years old.

 

 

 

 

 

The below chart lists the Coricidin HBP products available for  various Cold and Flu symptoms, as well as products suitable for day or nighttime.

 

 

Often, heart patients experience symptoms outside of cold and flu, such as gastrointestinal irritation. Below are some tips on OTC medications for these issues.

 

OTC GI Medications

• Abdominal bloating/gas
– Simethicone
• Constipation
– Miralax
– Senna
– Docusate
– Bisacodyl
• Nausea
– Calcium carbonate (Tums)
– Do not use Pepto-Bismol or any product with bismuth subsalicylate

 

Herbal Products

Another option to give careful consideration is the use of Herbal products. While the category name may sound safe, the product may not always be so.

• What supplements or herbal products should I avoid?
– List may change based on daily prescribed medications
– Ask your physician/advanced nurse practitioner/pharmacist before
starting any herbal products or supplements

 

Medication Optimization Tips

Get to know your pharmacist!
– Is there a local pharmacy that has “down” time or a counseling room?
– Do not be afraid to ask them questions
Use the same pharmacy to fill all your medications
– Occasionally a specialty pharmacy will need to be used
Request refills for prescriptions about 7 days in advance
Remember the new year
– Insurances often change
– Co-pays renew in January
Can you get a 3 month supply near the end of December?
– Prior authorizations may need to be renewed around this time!
Medication storage
– Keep away from direct heat or humidity
• Store OUTSIDE of bathroom
• Away from direct sunlight
– Avoid extreme cold temperatures
– Store in an easy to remember location
– Store medications away from children – locked up?
• Remembering to take your medications
– Take medications same time everyday
– Use pill boxes
– Use an APP on your phone
Medisafe – Pill & Med Reminder
CareZone – App

 

Additional Notes: Tips in case of Medication Changes by Other Providers: 

Keep an updated medication list with you at all times
Ask your pharmacist for counseling on all new medications
Ask your pharmacist to verify or double check your medications if
they look different when you pick them up
Call physician/advanced nurse practitioner for any changes in
cardiac medications by outside providers

 

Final Thoughts

Try to use single-ingredient over-the-counter products
– Ask about proper dose, including maximum dose per day allowed
Ask your pharmacist/physician/nurse practitioner about any new
herbal products
Use medication reminders for taking and reordering
Know when to call physician/nurse practitioners
Get to know your pharmacist!

 

Recommendations courtesy of : Justina Damiani, PharmD, BCPS

Justina Damiani is a clinical pharmacist at Lurie Children’s Hospital and primarily works in the cardiac intensive care unit. She received her PharmD from Purdue University. She completed two years of residency, the first at the University of Georgia followed by a pediatric pharmacy residency the University of Michigan. She enjoys running, yoga, and spending time in warm weather.