What Over-the-Counter (OTC) Medications and Vitamins Are Safe for Transplant Recipients?

It is important to tell your doctors all the medicines you are taking including prescription medicines, over the counter medicines, vitamins and herbal supplements. Certain medicines or supplements you may be taking can change the way transplant medicines work. This is called a drug interaction – when one medicine affects how another medicine works. Drug interactions can be dangerous and lead to organ rejection, infections, side effects, or affect other medical problems you may have.

The Penn Medicine Institute provides some general rules for its patients regarding over the counter medicines, vitamins and herbal supplements.

• Always talk to your transplant team before taking any new medicine including prescription medicines, over the counter medicines, vitamins and herbal supplements. When shopping for over the counter medicines and vitamins, look at the active ingredient section of the product label to identify safe/unsafe medicines. You will be given resources during your transplant education in the hospital that will help you identify which are safe and which are not safe. If you have any questions, call the transplant team.
• Single active ingredient products such as Tylenol® (acetaminophen) are better choices then combination products that may contain unsafe ingredients and include medicines that you may not need to treat your symptoms.
• Only acetaminophen (Tylenol®) can be safely taken for aches and pains after transplant. Do not exceed 3,000 mg per day. If you are a liver transplant recipient, your maximum dose of acetaminophen is 2,000 mg per day. Anti-inflammatory (NSAID) medicines such as ibuprofen (Advil®, Motrin®) naproxen (Aleve®, Naprosyn®) and aspirin (taken above the one tablet a day dose) can be harmful to your kidneys when you are on anti-rejection medicine.
• Avoid products containing the nasal decongestant pseudoephedrine (Sudafed®) as this can raise you blood pressure and heart rate. Products that contain pseudoephedrine usually have 'D' in the Brand name such as Claritin-D®
• Do not exceed the dose on the package or the dose recommended by the transplant team.
• Patients with diabetes should try to use sugar-free cough syrup.
• Herbal supplements are typically not allowed after transplant due to potential harm to the transplanted organ and drug interactions with the transplant medicines.
• Multivitamins are safe to take post-transplant but you must be sure they do not contain any ingredients that may be harmful including herbal supplements or ingredients that "boost" the immune system and increase the risk of rejection.
• When buying over the counter products including vitamins and supplements, only use products that contain "USP verified", "NSF certified" or "Made according to FDA Good Manufacturing Practices" on the label to ensure the product is safe.
• If you are ever unsure if a medicine, vitamin or supplement is safe, contact your transplant team before taking.

Here is a table summarizing information about over the counter medicines, vitamins, herbal supplements as well as fruits and teas. Use this table as a reference to avoid drug interactions to keep you safe and healthy.