Over the Counter Medications, Interactions, and Lupus

Many Lupus Warriors rely on over the counter medications to control their symptoms, but be careful – some may interact with lupus medications.

Over the counter medications, also known as OTCs, are legal drugs that can be purchased ‘over the counter’ at local grocery stories or pharmacies without a prescription. These include:

• Cough Syrup and Cold Medications
• Stimulants
• Pain Relievers
• Motion Sickness Medications
• Tobacco cessation aids
• Laxatives

These are easily seen and easily purchased, which makes them very useful for people with systemic lupus erythematosus (SLE.) However, while these drugs are not limited by prescription, they also are not harmless – in fact, OTC medications can cause surprising issues for people with lupus, interfering with both symptoms and treatments in potentially dangerous ways.

Medication Interactions, OTCs, and Lupus

Overuse of OTC drugs can cause mood swings, memory issues, depression, anxiety, and can change one’s appetite and sleeping patterns to less healthy levels – all of which can be disrupted by lupus. OTCs can also interact with prescribed medications and interfere with treatment in inconvenient – or dangerous – ways: 

Some medicines interact via “Duplication,” where the OCT and prescribed medicine do the same things, so it causes an overdose. Most commonly, this occurs with NSAIDs like Ibuprofen and pain relievers like acetaminophen, two OTC medications often used by people with lupus. Too much of this type of medication can cause damage to the kidneys and liver as the body tries to filter it out of the bloodstream and gets overwhelmed. 

Some interact by “Opposition,” where the medicines have opposite effects. They tug-of-war with each other, and the effectiveness of one or both medications is reduced. Sometimes, the opposing effect isn’t even the main active ingredient or desired effect, but a side effect of the OTC. 

Some interact by “Alteration,” where one medicine changes the way that the other medicine operates in the body. It can affect the processing of the medication, the absorption of the medication, or even the transport of the medication. A well-known example is aspirin, which can cause a blood-thinning effect, and also changes how other blood thinners operate in the body.

NSAIDs, Pain Relievers and Lupus

NSAIDs are used to reduce swelling, stiffness, pain, headaches and fevers even at nonprescription strength. Acetaminophen is not an NSAID and is not anti-inflammatory, but some brands combine it with aspirin. Over the counter NSAIDs are generally made for short-term use and can cause damage over long periods of time. A basic rule of thumb is 3 days straight for fevers and 10 days for pain, unless a doctor says otherwise.  When they prescribe NSAIDs, doctors generally use the lowest effective dose for the shortest time possible. 

Non-Steroidal Anti-inflammatory drugs work by preventing a class of enzymes known as cyclooxygenase-1 and cyclooxygenase-2 (COX-1 and COX-2) from producing signaling molecules associated with pain and inflammation. Many NSAIDs block both COX-1 and COX-2, which reduces inflammation but also reduces protection to the stomach lining and kidneys. Celebrex is formulated to only block COX-2. As a selective NSAID, it might be less likely to cause stomach problems associated with blocking COX-2. Antacids or taking the NSAID with food can reduce the effects of NSAIDs on the stomach. 

NSAIDs can cause gastrointestinal issues that include bleeding, poor absorption or processing of nutrients.

NSAIDS can conflict with ACE inhibitors, beta blockers, or diuretics (medicines that encourage urination to remove excess fluids,) and prevent them from properly working to prevent heart failure and high blood pressure. This can also overload the kidneys, which exacerbates kidney damage and certain other lupus symptoms. Kidney damage from overuse of NSAIDs or interactions with NSAIDs can be a major issue, especially if there are symptoms of lupus nephritis or other kidney damage. For people with lupus who may be more vulnerable to gastrointestinal, kidney, and nutritional issues, this can be additionally dangerous. You can read more about kidney damage and lupus here. 

Most NSAIDs, aside from aspirin, can cause higher blood pressure and increase the risks of heart attack and stroke. People with lupus are at increased risk of cardiovascular disease and stroke already, so this is something to consider. Aspirin is an anticoagulant, so it thins the blood and is considered to reduce the risks of stroke (ischemic stroke, not intra-cerebral bleeds,) and cardiovascular events. However, that can also be an issue for people taking blood thinners, because NSAIDs interact with blood thinners to increase the risk of bleeding.

Some people with lupus also use methotrexate (or rheumatrex,) a chemotherapy drug that is used as an immunosuppressant. This drug interacts with NSAIDs and increases the risks of liver toxicity and damage. 

Most of the time, taking over the counter NSAIDs is not too much of an issue for people with lupus. They just should be taken with care, under a doctor’s guidance, and not overused.

Antihistamines, Allergy Medications, and Lupus

Antihistamines are used to treat the symptoms of allergies. Usually, they are used to treat seasonal allergies like pollen but also help with allergies to other, usually external, triggers, such as food, dust, mold, and insect bites. Antihistamines can also help treat allergies to certain medications and drugs, stomach problems, colds, and even anxiety. Antihistamines can safely be taken daily, and do not have medical interactions. However, the side effects might make other lupus symptoms worse. 

In particular, antihistamines can interact with sleeping medications, pain medications, antidepressants, and seizure medications, and can make existing drowsiness worse. Newer antihistamines are less likely to cause drowsiness and other side effects. 

Additionally important for people with lupus, many anti-allergy medications contain corticosteroids, which are also often prescribed for lupus. People prescribed corticosteroid medications or creams should use those to treat their lupus symptoms and not also purchase. 

Mouthwash, Oral Products, and Lupus

People with lupus have to take special care of their extra-vulnerable mouths, but even certain oral health supplies, such as toothpastes and mouthwashes can cause interactions. 

50% of people with lupus endure painful sores in their mouth, also known as mouth ulcers or “canker sores.” These sores can form after an injury to the mouth or can come and go with hormone cycles and as a part of a lupus flare. Mouth ulcers can make eating and drinking difficult and also act as a way for bacteria to enter the body. Many people with lupus also experience xerostomia or dry mouth, a condition where not enough saliva is produced in the mouth.

Both can be treated with regular and gentle toothbrushing, flossing, mouthwashes. However, mouthwash containing alcohol can actually make dry mouth worse, and some mouthwashes can irritate the inside of the mouth and make it more vulnerable to being damaged. Sodium lauryl sulfate, found in mouth rinses and toothpastes can sometimes even spread the sores, though this is less common.

The American Dental Association recommends buying mouthwash with fluoride instead. Mouthwashing can also disrupt the natural microbiome of the mouth, which also makes infections more likely. Using gentler formulas can help preserve the microbiome and, potentially, reduce the tingling or burning sensation that many mouthwashes leave behind. 

An alternative, especially for other types of injuries inside the mouth, is to rinse with salt water. This kills the bacteria and is less likely to cause drying. 

Other OTC Medications and Lupus

Some medications, especially cold medicine, can cause a high and hallucinations, as well as a wide range of neurological symptoms if overused. This is because of the active ingredients dextromethorphan  – which numbs the discomfort that leads to coughing –  and pseudoephedrine  – which is a stimulant that relieves sinus congestion and narrows blood vessels in the nasal passages. Because these work directly on the nervous system, overuse of cough medications to treat persistent coughs or colds can make already existing neurological symptoms worse. For people with lupus who are also treating depression, anxiety, or other mental health symptoms, these chemicals can affect how other neurological medications work in their body. 

Motion sickness medications like Dramamine contain dimenhydrinate, which acts as both an antihistamine and inhibits the neurotransmitter acetylcholine. This blocks the feeling of disorientation and nausea, and in normal doses, this drug can be very helpful. In high doses, it can cause a ‘high’ with psychedelic affects and can cause issues throughout the brain and nervous system, including hallucinations, ringing in the ears, heart palpitations, seizures, and can even lead to coma and death. Fortunately, most of these symptoms occur at very high doses, but people with lupus who are taking medications for similar issues should check with their doctor to make sure that their medications will still be effective.

People with lupus frequently have to deal with gas, heartburn, indigestion, and acid reflux, among other gastrointestinal woes. There are many over the counter remedies for these. However, some of the most common medications have drug interactions; Antacidsv can affect how medicines are absorbed into the body. Corticosteroids can interact with laxatives and diuretics. 

Antidiarrheals and anti-gas OTC medications also often contain loperamide, which is sometimes used by people experiencing opioid withdrawal to relieve their symptoms. Overuse – or use with narcotic opioid-based painkillers – can cause abnormal heart rhythms, including cardiac arrest and a rapid heart rate, potentially leading to unconsciousness. 

Proton pump inhibitors such as omeprazole are used to treat gastrointestinal issues and heartburn. This reduces the amount of acid produced by the stomach, protecting the stomach lining. However, lower levels of acid can also cause infections as more bacteria survive the stomach acid.

On the skin side of things, lotions and creams, both medicated (usually with corticosteroids,) and not, can be a boon for the skin of people with lupus. However, medicated creams might accidentally dose you with too much of that anti-inflammatory, and other lotions might have ingredients that could trigger an allergy or a flare. Always check the ingredients list and make sure you aren’t allergic before using. 

Allergies to OTCs can affect lupus symptoms, too – be careful out there!

A Lupus Warrior’s Takeaway

NSAIDs and other over the counter medications are powerful tools for lupuswarriors hoping to manage their symptoms. This is not a warning not to take OTC medications, but to take them carefully. For the most part, if the dose and frequency of OTCs is low, then it’s not usually a problem. However, people with lupus often find themselves needing to take OTCs often, so if there is one that you take particularly frequently, such as ibuprofen or cough medicine, then it might be time to take a look at your prescriptions again and adjust things.

This article doesn’t deal with herbal supplements, but they have important interactions with common lupus and lupus-adjacent medications like warfarin, blood thinners, and blood pressure medicine.  OTC drugs can be abused or overused as well and have the potential for serious side effects. You can read more about them here. 

There are many dangerous interactions that over the counter drugs and supplements can have with each other – Men’s Health has a very extensive article here. 

Always inform your treatment team about the medicines that you typically use, even vitamins, herbal supplements, and even your general diet. However, pharmacists can help act as a first line of defense, as they know about the OTC drugs and their interactions, so if you have access to a pharmacist, you can ask them at the point of sale.