OVER-THE-COUNTER (OTC) Medications

[cyberelijah]

Over-The-Counter (OTC) Medications in Benzo Tapering

Whenever an over-the-counter item is taken with a prescription medication, there’s a chance of an interaction between them. This interaction could affect the effectiveness and/or side effects of the medications, and even result in a new side effect not typically seen with the medications alone. The likelihood of drug interactions increases with the number of combinations. Most drug interactions occur due to altered absorption in the intestine, which can change blood flow to the intestines, metabolism of the drug by the intestine, increased intestinal movement leading to diarrhea or constipation, alterations in stomach acidity, and changes in the gut bacteria. The liver and kidneys are crucial sites for drug elimination, making them important areas of drug interactions. Drug interactions can be complex and unpredictable, so minimizing the risk is essential.

! Antihistamines (Benadryl, Dimetapp, NyQuil, Alka-Seltzer Night-Time Cold, Thera Flu, etc.):

Over-the-counter (OTC) antihistamines are drugs that temporarily relieve a runny nose, or reduce sneezing, itching. Antihistamines, commonly used to treat allergies, can have adverse effects when combined with other medications. They can cause itchy watery eyes, nasal congestion, and throat irritation. Additionally, antihistamines enhance the sedative properties of benzodiazepines and sleeping pills, leading to cognitive impairments, dangerous drops in blood pressure, suppression of the lungs, and extreme sedation. Furthermore, antihistamines alter the metabolism of many selective serotonin reuptake inhibitors (SSRIs), resulting in increased blood levels of the antidepressant and heightened side effects. Combining antihistamines with hypertension medication can further exacerbate these effects, potentially leading to an increase in heart rate and blood pressure.

 

! Nasal Decongestants (Afrin, Neosynephrine, Sudafed, etc.):

Most nasal decongestant sprays cause increased adrenaline and norepinephrine, which can exacerbate anxiety and depression. Prolonged use of decongestants for more than 3-5 days can damage nasal tissue and result in chronic congestion. Additionally, nasal decongestants may diminish the effectiveness of certain blood pressure medications. Common side effects include stomach upset, difficulty sleeping, dizziness, lightheadedness, headache, nervousness, rapid heartbeat, decreased appetite, and shaking.

 

! Pain Relievers (Acetaminophen - Tylenol, Excedrin, etc. / Ibuprofen - Motrin, Advil, etc.):

Painkillers like Acetaminophen and Ibuprofen, known as analgesics, numb pain. However, they can significantly impact other medications, nutrient absorption, and overall health. Acetaminophen, or Paracetamol, a widely used over-the-counter pain reliever and fever reducer derived from coal tar, has been linked to reduced glutathione production, the body’s primary antioxidant. Acetaminophen is primarily metabolized in the kidneys, with a smaller amount passing through the liver. In the liver, a toxic by-product called N-acetyl-p-benzoquioneimine (NAPQI) is formed in response to acetaminophen, posing a severe risk to liver health. Common side effects of acetaminophen include nausea, vomiting, loss of appetite, diarrhea, sweating, irritability, abdominal pain (especially near the liver), yellow eyes or skin, liver or kidney failure, heart problems, and seizures. Ibuprofen, on the other hand, reduces melatonin levels and may disrupt sleep if taken at bedtime.
 

Other drugs that interfere with melatonin production are Valium, Xanax, diuretics, beta-blockers, calcium channel blockers. Alcohol and caffeine can also cause anxiety and depression. Ibuprofen disrupts the hormone system that controls muscle, blood vessel, and inflammation contraction and relaxation. Side effects include rash, ear ringing, headaches, dizziness, abdominal pain, nausea, diarrhea, constipation, heartburn, bruising, tingling, numbness, nervousness, depression, and insomnia.
 

 

! Stomach Relievers (Maalox, Tums, Tagamet, Prilosec OTC, Pepcid, Zantac, etc.):

Over-the-counter medications that reduce stomach acid production can disrupt the natural balance of healthy bacteria essential for good health, allowing unhealthy bacteria to thrive. Proton-pump inhibitors (PPIs) not only block stomach acid production but also increase the risk of a common infectious form of diarrhea caused by Clostridium difficile bacteria. Taking heartburn medications like Nexium or Losec significantly amplifies this risk. Frequently prescribed anti-heartburn drugs called H2 antagonists, such as Zantac or Prevacid, double the likelihood of bacterial diarrhea. PPIs and H2 antagonists reduce gastric acid, enabling bacteria to multiply in the digestive system. While antibiotics, once blamed for outbreaks of the illness, have declined in use, acid-blocking drugs have become increasingly popular to treat ulcers and conditions like gastric reflux disease.
 

Furthermore, stomach medications can slow the absorption of benzodiazepines and sleeping pills, leading to heightened anxiety and insomnia. Combining antacids with antibiotics, heart and blood pressure, or thyroid medications can reduce their absorption by up to 90 percent and may pose a concern with certain antidepressants. Additionally, antacids bind to nutrients, hindering proper absorption.
 

Medications for GERD and acid reflux can enhance the effects of benzodiazepines in your system. Proton pump inhibitors (PPIs) are the most effective antisecretory agents used to treat acid-related disorders. Consequently, they are often prescribed to patients who are simultaneously taking other medications. PPIs can interact with other drugs through various mechanisms. The most significant ones include competitive inhibition of hepatic cytochrome P (CYP) 450 enzymes involved in drug metabolism and alterations in the absorption of other drugs due to changes in gastric pH levels. Individuals who lack CYP2C19, known as poor metabolizers, may be particularly susceptible to drug interactions. Although the potential for drug interactions is high, few clinically significant interactions have been reported for PPIs. Nevertheless, caution is advisable when certain drugs are co-prescribed with these agents. The likelihood of clinically significant drug interactions increases with the number of drugs taken and the age of the patient. The drug interaction with the greatest clinical significance is the reduced clearance of benzodiazepines by omeprazole.
 

--Division of Gastroenterology, Stanford University School of Medicine, CA, USA. MAY

Added information and noted contraindications:

 

! Activated Charcoal:

Activated charcoal can cause an acute withdrawal reaction when used while on benzodiazepines as it absorbs and reduces the dose of the drug.
 

If your question is not answered in this list feel free to ask in the group and double check on drugs.com for interaction.