SAFE OVER THE COUNTER MEDICATIONS FOR

TRANSP L ANT RE C IP IE N TS
PEN N TR A N S P L ANT I NST I T U TE

The Penn Transplant Institute provides some general rules for patients regarding
over the counter medications (OTC), vitamins and herbal supplements. Transplant
medications can be affected by other medications or supplements you may be
taking. It is important to communicate all the medicines you are taking to your
transplant team including prescription medications, over the counter medications,
vitamins and herbal supplements. Use this table as a reference to avoid drug
interactions to keep yourself safe and healthy.

If you received a heart transplant, ask your transplant coordinator for advice before using any OTC medications.

Problem ✓ OR X Generic Medication Name Common Brand Names Notes

Abdominal Mylicon®, Mylanta Gas®,
Bloating/ Gas ✓ Simethicone
Gas-X®, Digel®, Gelusil®
Diphenhydramine, Loratadine,
Cetirizine, Fexofenadine,
Levocetirizine, Cromolyn Benadryl®, Claritin®, Zyrtec®

Allergies
✓ nasal spray, Triamcinolone Allegra®, Xyzal®, NasalCrom®,
Acetonide nasal spray, Nasacort®, Astepro®, Flonase®
Azelastine nasal spray,
Fluticasone nasal spray
X AVOID Claritin D®, Zyrtec D®, or Allegra D® (the D is for decongestants, which should be avoided)
Chlorpheniramine,
Sneezing, Chlortrimeton®
Runny Nose ✓ Chlorpheniramine
Coricidin HBP Cold and Flu®
and Acetaminophen
Mucinex®, Robitussin® (plain)
Combination products with
dextromethorphan are also allowed:
✓ Guaifenesin
Robitussin DM®, Mucinex DM®,
Congestion
Coricidin HBP Chest Congestion and
Cough®, Equate Tussin DM®

X AVOID decongestants like pseudoephedrine (Sudafed®) or phenylephrine (Sudafed PE®)

• Unless on a fluid restriction,

keep yourself well hydrated
Docusate, Senna, Psyllium, Colace®, Senokot®, by drinking at least EIGHT
Constipation ✓ Bisacodyl, Polyethylene glycol Metamucil®, Dulcolax®, glasses of fluid a day.
3350, Milk of Magnesia, Fiber Miralax®, Phillips®, Fiberall® • For colonoscopy
preparation, follow the
instructions from your doctor.

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Problem ✓ OR X Generic Medication Name Common Brand Names Notes
Robitussin Cough Gels®, Delsym®,
Dextromethorphan Robitussin DM®, Coricidin HPB®

Note: if you have Combination products with

Cough ✓ diabetes, look for a guaifenesin are also allowed:
product free of sugar Robitussin DM®, Mucinex DM®,
and alcohol. Coricidin HBP Chest Congestion
and Cough®, Equate Tussin DM®
Imodium A-D®, Imodium
• Notify a coordinator if you have diarrhea
✓ Loperamide Multi-Symptom Relief®
for greater than 24 hours or if you also
(contains simethicone)
have fever and abdominal pain.
Diarrhea
AVOID any Pepto-Bismol™ product or any product • Unless on a fluid restriction, keep
yourself well hydrated by drinking at
X with bismuth subsalicylate in it unless prescribed
least EIGHT glasses of fluid a day and
by your physician
increase your salt intake.

Acetaminophen
✓ only
Tylenol® • You can take up to 3000 mg in a 24-
hour period. If you received a liver
transplant, DO NOT EXCEED 2000 mg.*
• Notify a coordinator if your fever rises
above 100.4oF.
Low-grade
AVOID methyl salicylate or any non-steroidal anti- • Many combination products contain
Fever, Joint acetaminophen, also known as APAP.
Aches, inflammatory (NSAIDs) medications like ibuprofen
Check the labels of all medications you
Headache X (Advil®,Motrin®, Advil Dual Action®), naproxen (Aleve® or
are taking for pain or cold (prescription
Naprosyn®), aspirin (avoid doses higher than baby aspirin or
and over-the-counter) to make sure you
81 mg), or ketorolac (Toradol®)
stay under the maximum dose per day.
• Ketorolac (Toradol®) is not available as
OTC, but it is a prescription NSAID that
should still be avoided if at a hospital.

Sodium Chloride
Dry Nose ✓ Nasal Spray/Drops
Ocean Spray®

Tums® • If you require any of these products

for more than 3 days in a row for
indigestion, contact your transplant team.
Rolaids®, Gaviscon®, Acid Gone®,

✓ Calcium carbonate Alamag®, Gelusil®, Maalox • If you are taking medications to treat/
Advanced formulations®, Mylanta prevent HIV or antibiotics, check with
Indigestion
Classic formulations®, Milk of the transplant team before starting a
Magnesia formulations such as calcium-containing antacid.
Phillips Milk of Magnesia®
• If you received a lung transplant, check
with team before taking any OTC
X AVOID Alka Seltzer® as it contains aspirin for indigestion.

Famotidine Pepcid AC®

Lansoprazole, Prevacid®, Prilosec OTC®,
• If you received a lung transplant, call
transplant team if indigestion/heartburn
Omeprazole, Nexium 24 hr®, Zegrid OTC®
✓ Esomeprazole,
getting worse and ask before taking any
additional OTC medication.
Heartburn Omeprazole/Sodium
Bicarbonate • If used, Lansoprazole, Omeprazole,
and Esomeprazole should not be taken
AVOID Tagamet HB® or Tagamet® (Cimetidine)
“as needed”, as they work best when
X Do not take any products that contain the ingredient taken regularly.
cimetidine as it can interact with some of your medications
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Problem ✓ OR X Generic Medication Name Common Brand Names Notes

Kefir cultured milk products/

yogurt products may be Lifeway®, The Greek Gods®,
✓ used as an alternative to Wallaby Organic®
probiotic supplements.

Probiotic

AVOID use of probiotic supplement capsules, tablets, or packets such as Lactobacillus acidophilus,
X Saccharomyces boulardii. Common Brand names include Align®, Activia®, Florastor®, ProBiotic Restore®,
Probiata®, Culturelle®

Dramamine®, Dramamine
Motion • Caution as these can make
Sickness ✓ Dimenhydrinate, Meclizine Less Drowsy Formula®,
you drowsy.
Bonine®, Antivert®

Salonpas Pain Relieving Hot

Gel Patch®, Aspercreme with
Lidocaine Maximum Strength®,
IcyHot Medicated Patch®, IcyHot
Pain Relieving Gel®, Biofreeze
Lidocaine, Menthol,
✓ Camphor, Capsaicin
Pain Relieving Gel®, Bengay
Vanishing Scent®, Tiger Balm
Ultra Strength®, IcyHot Advanced
Muscle Aches Relief®, IcyHot Lidocaine Plus
and Pain Menthol® (patch or cream),
Capzasin HP Arthritis Pain Relief®

AVOID methyl salicylate or any non-steroidal anti-inflammatory • Ketorolac (Toradol®) is not

(NSAID) medications like ibuprofen (Advil®, Motrin®, Advil Dual available as OTC, but it is a
X
Action®), naproxen (Aleve® or Naprosyn®), aspirin (avoid doses prescription NSAID that should
higher than baby aspirin or 81 mg), or ketorolac (Toradol®) still be avoided if at a hospital.

Luden’s®, Vicks®, Chloraseptic®,

• If you have diabetes, look for
Sore Throat ✓ Menthol, Benzocaine NICE®, Halls®, Cepacol
sugar-free lozenges.
Lozenges®

• If you require any of these products

for more than 7 days in a row for
sleep, contact your transplant team.

Diphenhydramine, Simply Sleep®, Unisom®,

• If you received a lung transplant,
Sleep ✓ Doxylamine, Melatonin Benadryl®, Zzzquil®
check with your team before taking
any OTC for sleep.
• For melatonin, only purchase
products that contain “USP verified”
on the label.

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Vitamins and Minerals Generally Safe After Transplant General Guidance

• This is a list of vitamins and minerals generally safe

when found in small amounts in multivitamins or
A Ferrous sulfate other combination vitamin products. Always talk to
your transplant team before starting any OTC vitamin
B1 (thiamine) Folic acid supplement. Some vitamins or minerals taken daily may be
B2 (riboflavin) Iodine harmful to you.
B3 (niacin) Lycopene • Certain vitamins and minerals, including vitamin C (ex.
Airborne®, Emergen-C®), vitamin D, and zinc, may not be
B5 (pantothenic acid) Manganese
preferred for long-term use due to their potential to be
B6 (pyroxidine) Magnesium amino acid chelate “immune boosting.”
B7 (biotin) Magnesium chloride • Herbal supplements, diet pills, weight loss supplements,
B12 (cyanocobalamin) Magnesium oxide herbal remedies, fruit and vegetable supplements, and
plants/herbs in quantities larger than used in cooking
C (ascorbic acid) Magnesium glycinate
should all generally be avoided due to the risk of
D (ergocalciferol, cholecalciferol) Slow-Mag interacting with your transplant medications and causing
E Nicotinamide rejection or harm to your new organ, infections or side
effects. Talk with your transplant team if you are interested
K Potassium chloride in starting any new supplement.
Calcium carbonate Potassium phosphate
• Only use products that contain “USP verified,”
Calcium citrate Selenium “NSF certified” or “Made according to FDA Good
Manufacturing Practices” on the label.
Chromium Sodium bicarbonate
Copper Sodium acetate
Ferrous (fumarate, gluconate) Zinc

Fruits Recommendation General Guidance

Grapefruit, Pomelo,
Avoid eating fruits, seeds, or juices.
• Because some fruits can interact with your medications,
Seville Orange we recommend avoiding some altogether, while only
sparingly eating others.
Tangelo,
Pomegranate, Only occasionally eat fruit, seeds, or juices. • Be sure to read the label of fruit juices, fruit punches, and
iced teas carefully, as some may contain fruits that should
Minneola, Star Fruit
be avoided.

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 Teas to Limit
Preferred Herbal Teas Teas to Avoid General Guidance
(1 – 2 cups per day)

Bergamot flavoring
(Earl Grey, Paris)
Chamomile
Valerian
Hawthorn
Plain black tea Rooibos • To the left is a list of which common teas are safe to
(Lipton®, English consume after transplant.
Breakfast) Green / Matcha (avoid Ginger
green tea extract)
• Always avoid herbal “remedies” or other combination
Most food-type Turmeric (Curcumin) herbal products. These may be harmful to your new organ
flavorings are fine Yerba mate Cordyceps and interact with your medications.
(such as apple,
lemon, mint, caramel)
Lemongrass (Cordyceps
• Note that caffeine contained in select teas can cause
mushroom) excess urination. Closely monitor your fluid intake and
Chai Dandelion weight if drinking caffeine.
Echinacea
(Coneflower, Black
Sampson)
Ginseng
Feverfew

N A T I O N A L LY R E C O G N I Z E D
PENN TRANSPLANT INSTITUTE
E B R AT I N
EL The most experienced major organ transplant center in
55
G
C

OVER
OF
YEARS the region where nationally recognized multidisciplinary
TRANSPLANT teams, innovative research and compassionate patient
EX
CELLENC
E
care deliver outcomes that exceed national averages.

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FY24 39069 07.23

For more information, visit PennMedicine.org/Transplant.