Kidney-Transplant patients
What Over-the-Counter (OTC) medication can you take?
Our kidneys are situated at the lower back behind the stomach, one is situated each side of the
spinal cord. The lower ribs act as a cage for the kidneys preventing injury. Each kidney is
approximately the size of your fist. The kidneys' main roles are:
 Filter waste products and excess water from the blood
 Produce hormones to regulate blood pressure and red blood cell production
 Maintain balance of water, salts and acid
Kidney Failure
Kidney failure is usually caused by a condition that prevents them functioning normally including the
likes of diabetes mellitus, high blood pressure, polycystic kidney disease and glomerulonephritis.
Injury and birth defects can also cause kidney failure. Damage to the kidneys from a condition like
diabetes can take years before the effects of kidney failure start to be noticed. A sudden loss of
kidney function is rarer but can occur due to some conditions. Kidney failure causes problems like a
build-up of waste products and fluids and you end up developing side effects like tiredness and
fatigue, oedema (swelling) in your ankles and face, nausea and a poor appetite.
Benefits of Kidney Transplantation
Kidney transplants are not a cure but they allow you maintain a normal standard of living. A
successful kidney transplant should mean you no longer need dialysis. Energy levels increase as the
new kidneys starts producing red blood cells. Fluid and diet restrictions should end.
Medication to avoid
Some medications interfere with the immunosuppressive medications. They can include cold, allergy,
cough syrup or antibiotics. Antibiotics to avoid include clarithromycin (Klacid®), erythromycin and
azithromycin (Zithromax®). Other drugs to avoid include the antifungal fluconazole (Diflucan®) and the
heart rhythm drug diltiazem (Dilzem®).
AVOID grapefruit or grapefruit juice when prescribed Neoral®, Prograf® or Rapamune®, as it changes
the metabolism of these medications. Avoid Magnesium Oxide or antacids such as calcium
carbonate, Rennies®, Maalox® or Gaviscon® within 2 hours of taking your medications as they may
reduce absorption of some drugs such as immunosuppresants and antibiotics.
Herbal preparations and supplements
There are very few scientific studies indicate whether herbs are effective, safe, or interfere with
prescribed medications. Herbs can cause serious interactions and kidney problems for patients with
renal failure and those taking medications after a transplant.
Possible issues with herbs:
 Interactions between herbs and transplant medications including reducing the effectiveness
 Herbs may not be pure because of unregulated manufacture procedures. Herbs come from plants
that may cause bacterial, fungal, or parasitic infections. There have been reports of herbs
containing pesticides and metals including lead and mercury.
 Some herbs are toxic effects to the liver, kidneys, and heart, especially when taken with other
medication including changes in blood pressure, blood sugar and potassium levels leading to risk
of bleeding and transplant rejection.
 Dosages can vary from pill to pill, manufacturer to manufacturer or from what is stated on the
label.
To be safe, transplant patients should avoid herbal preparations.
What Over the Counter Medication is safe?
Headache, Fever, and Body Aches
Paracetamol eases mild pain and fever and is safe for kidney transplant patients. The maximum daily
dose of paracetamol is 4000 mg (8 x 500mg tablets).
Non-steroidal anti-inflammatory drugs (NSAIDs) must be avoided as they can harm the kidneys and
interact with some immunosuppressants. Ibuprofen (Nurofen®) is a common NSAID sold over the
counter. Aspirin is a relation of NSAIDs so should also be avoided unless prescribed for medical
reasons (eg) low dose aspirin to prevent clots
Sneezing, Itching and Runny Nose
Antihistamines can be safely used by transplant patients. Loratadine (Clarityn®) and cetirizine
(Zirtek®) are recommended as they cause less drowsiness than other anti-histamines.
Chlorpheniramine (Piriton®) is also safe to use but is best used at bedtime as it causes more
drowsiness. Antihistamines should be used with caution for those with glaucoma as they can
increase pressure in the eye. They can also cause fluid retention so are best avoided in those with an
enlarged prostate or if you have trouble urinating. Sodium Cromoglycate Eye Drops (Opticrom®
drops) are a safe option to prevent eye allergy symptoms. It works best if begun at least one week
before contact with possible allergens.
Avoid combination (multi-symptom) cold, sinus, and flu products (Benilyn Day & Night®, Benylin
4Flu®, Nurofen Cold and Flu®). Treat each symptom individually to avoid accidentally taking a drug
that can cause kidney problems.
Nasal and Sinus Congestion
Topical nasal sprays are the safest for congestion problems. Topical decongestants such as
xylometazoline (Otrivine® and Sudofed® Nasal Spray) should not be used for longer than three days
because longer use can cause a re-bound effect making congestion worse. Sodium chloride 0.9% or
salt sprays (eg. Sterimer®) can ease sinus systems by moistening sinus cavities and acting as a
natural anti-inflammatory, they can safely be used long term. Saline (salt) solutions are also available
as nasal washes through various devices or bottles (eg) Neilmed Sinus Wash®.
Oral decongestants, such as pseudoephedrine (Sudafed® tablets) should be used with care for
transplant patients as they can raise blood pressure which can put pressure on kidneys.
Decongestants are ingredients in many cough and cold remedies so check the label before trying.
Sore Throat
Most throat lozenges (eg. Strepsils®) are safe to use and there are sugar free versions for diabetics.
Chesty Cough
Guaifenesin (Robitussin®, Viscolex® or Exputex®) is recommended for chest congestion. Drinking
plenty of water can help loosen chest congestion.
Dry Cough
The cough suppressant dextromethorphan (Benilyn® Dry Cough) is safe to use (use the non-drowsy
version during the day as the night time version has a sedative anti-histamine called
diphenhydramine added).. Vicks VapoRub® can help relieve a cough for a time. If you have diabetes,
use a sugar free version such as Robitussin® Dry Cough Mixture
Diarrhoea
Loperamide (Imodium®) can be used for short-term relief of diarrhoea. Do not use for longer than 48
hours. For diarrhoea caused by infection, do not treat it with OTC products. If diarrhoea is heavy,
bloody, or lasts for more than a day it is important to get checked by a doctor.
Constipation
Products safe to use for transplant patients include bulk-forming products (Fybogel®); stool softeners,
such as docusate (Fletchers enema®); stimulants such as bisacodyl (Dulcolax®) or senna (Senokot®)
and osmotic laxatives such as lactulose (Duphalac®) and Macrogols (Movicol®, Molaxole®). Do not
use stimulant laxatives such as bisacodyl or senna long term as it will cause lazy bowel (which
causes re-bound constipation), prolonged diarrhoea and loss of important electrolytes (sodium,
potassium, etc). Lactulose (Duphalac®) is a good option if a laxative is needed long term as it doesn’t
cause long term problems caused by some other laxatives like lazy bowel. If constipation last longer
than 48 hours you should see your doctor.
Indigestion and heartburn
Mild stomach upset can be eased with some over the counter remedies such as antacids (eg.
Rennies®, ranitidine (Zantac®); famotidine (Pepcid AC®) and pantoprazole (Pantup Relief®). Avoid
antacids or magnesium-containing products at the same time as immunosuppressants such as
mycophenolate (Cellcept®), tacrolimus (Prograf®) or sirolimus (Rapamune®) as they can reduce
absorption of these drugs. Take OTC remedies such as antacids at least one hour before or two
hours after the immunosuppressant. If you have loose stools, avoid containing magnesium products
like Maalox®, because magnesium can make diarrhoea worse or worse again, they can cause your
magnesium levels become too high, especially if your kidneys are not functioning properly.
Gas
Simethicone (Imogas®) is recommended for gas which is a common cause of bloating.
Dry Eyes and Eye Irritation
Artificial tears eye drops should be first choice for the symptoms of dry eyes and eye irritation. They
replicate the role of natural tears. Drops are often used during the day (eg. three times daily) and an
ointment or gel is used at night as they are thicker and tend to last for longer while you sleep. Brands
include here is no evidence that one brand is any more effective than the next. Examples include
Tears Naturale® and Artelac Drops®. They should not be used for contact lens-associated irritation.
Nausea and Vomiting
Domperidone (Motilium®, Domerid®) can be used to treat and prevent symptoms of nausea and
vomiting but should only be used short term and at the lowest possible dose (maximum of one 10mg
tablet three times daily). See your doctor if nausea and vomiting lasts more than 24 hours as it can
be caused by your prescription medication.
Skin Irritation, Insect Bites and Poison Ivy
Topical corticosteroids, such as hydrocortisone 1% cream (Cortisol 1% Cream), is safe to use for
skin irritation, insect bites, and skin rashes. Use of corticosteroids should be short term (no longer
than 7 days) as they can thin and mark the skin if used long term.
Summary of safe OTC products for transplant patients
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Headache, fever, body aches:
Sneezing, itching, or runny nose:
Paracetamol
Chlorpheniramine (Piriton)
Brompheniramine (Actifed)
Nasal and sinus congestion:
Xylometazoline (Otrivine spray)
Sodium Chloride 0.9% (Sterimer
Nasal spray)
Pseudoephredrine (Sudofed)
Chesty cough:
Guaifenesin (Robitussin)
Chesty cough with congestion: Guaifenesin/Pseudoephredrine (Robitussin Plus)
Sore throat
Antiseptic lozenges/spray (Strepsils)
Constipation:
Lactulose (Duphalac)
Bisacodyl (Dulcolax);
Senna (Senokot)
Suppositories (Glycerin)
Diarrhoea
Loperamide (Imodium)
Indigestion/Heartburn
Famotidine (Pepcid AC)
Pantoprazole (Pantup Relief)
Gas/bloated stomach
Simethicone (Imogas)
Dry eyes and eye irritation
Artificial Tears(Tears Naturale, Artelac Drops)
Skin irritation, insect bites, rashes
Hydrocortisone 1% cream
Nausea & vomiting
Domperidone (Motilium, Domerid)
Become a donor
Give the gift of life, become an organ donor today. For an organ donor card, contact the Irish Kidney
Association on LoCall 1890 543639 or logon to www.ika.ie
Disclaimer: Please ensure you consult with your healthcare professional before making any changes
recommended
For comprehensive and free health advice and information call in to Whelehans, log on to
www.whelehans.ie or dial 04493 34591. You can also e-mail queries to info@whelehans.ie.