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

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. In Liver Transplant OTC Medications can be affected by other medications or supplements you may be taking. This is called a drug interaction – when one medication affects how another medication works. Drug interactions can be dangerous and lead to organ rejection, infections, side effects, or affect other medical problems that could impact your quality and quantity of life.

The Penn Medicine Liver Transplant Team provides some general rules for its patients regarding over the counter medications, vitamins and herbal supplements.

• Always talk to your transplant team before taking any new medication including prescription medications, over the counter medications, vitamins and herbal supplements. Education packets will include a table summarizing which products are safe and unsafe post-transplant.
• When shopping for over the counter medications and vitamins, look at the active ingredient section of the product label to identify safe/unsafe medications.
• Single active ingredient products such as Tylenol® (acetaminophen) are better choices then multi-active ingredient products or combination products that may contain unsafe ingredients and include medications 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 2,000 mg per day. Anti-inflammatory (NSAID) medicines such as ibuprofen (Advil®, Motrin®) naproxen (Aleve®) and aspirin (taken above the one tablet a day dose) can be harmful to your kidneys when you are on anti-rejection medication.
• Avoid products containing the nasal decongestant pseudoephedrine (Sudafed®) as this can raise you blood pressure and heart rate. Products that contain psudeophedrine 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 medications.
• 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.
• If you are ever unsure if a medication, vitamin or supplement is safe, contact your transplant team before taking.

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