by Larry B. Silver, M.D.
If you or your child is prescribed medications such as methylphenidate (Ritalin), dextroamphetamine (Dexedrine), dextroamphetamine/leveoamphetamine salts (Adderall), or atomoxetine (Strattera) to treat AD/HD, do you have to worry about using certain over-the-counter (OTC) medications?
Can you use cough medications and cold medications? Or medications for diarrhea or constipation? Medications for headaches? This is an important question, and finding the answers isn't an easy task.
I myself had to go to the pharmaceutical literature provided by the drug manufacturer for each of the medications used and study the "fine print," but you can do the same by looking in the Physician Desk Reference online at www.PDR.net. Click on the "drug interactions" entry. Then follow the guidelines, entering each of the medications you have in question. If there are drug interactions, it will be noted. Here's what I learned about the most common AD/HD medications:
No adverse reactions to OTC drugs were listed for the brand or generic forms. No adverse reactions were noted for the long acting forms of this medication (Metadate, Ritalin LA, Concerta).
or Dextroamphetamine/Levoamphetamine (Adderall) Several reactions to OTC items are listed for this AD/HD Medication, including: Acidifying agents - These agents (e.g., ascorbic acid or "Vitamin C") are used to increase the acid level in the stomach. They will lower the absorption of the amphetamine. Thus, a higher dose of the amphetamine may be needed.
Alkalinizing agents - These agents (e.g., sodium bicarbonate or "baking soda," a common ingredient in antacids) are used to decrease the acid level in the stomach. They cause an increase in the absorption of amphetamines. Thus, they should not be used with an amphetamine.
Antihistamines - Amphetamines may counteract the sedative effect of antihistamines. This effect might be advantageous.
No adverse reactions to OTC drugs are yet listed.
Overall, there are not many contraindications for OTC medications reported by drug manufacturers for AD/HD prescriptions. If you or one of your family members are on AD/HD medication plus another prescription medication, however, the physician prescribing the medications should be aware of any possible interactions and should inform you. If you are seeing a new or different doctor or pharmacist, be sure they are aware of any other prescriptions you are taking so that they can review possible contraindications. You can always visit the PDR online if you are uncertain about any new medications.
Dr. Larry Silver is a child and adolescent psychiatrist, clinical professor of psychiatry and director of training in child and adolescent psychiatry at Georgetown University Medical School. He is also president of the Learning Disabilities Association of America. He is a former acting director and deputy director of the National Institute of Mental Health.
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- A Good Reason to Say "No" to the Nog
It's never a good idea to overindulge at holiday happy hours, and for adults taking AD/HD medications, it's wise to remember that stimulants and alcohol are not good together. Stimulant AD/HD medications potentiate alcohol, meaning even if you only have a small amount of spiked "nog" at the office party, you may feel "drunk" faster than you might off medication. Other medications that might be taken for depression, anxiety, or other disorders, might also potentiate the impact of alcohol. Clarify any concerns you may have about this with your prescribing physician.